Treatment of symptomatic popliteal artery aneurysms with venous bypass by the AESA (asymmetric end-to-end spatulated anastomosis) technique

We report 6 cases of critical limb ischemia in 4 patients due to symptomatic popliteal artery aneurysm and we present the AESA (asymmetric end-to-end spatulated anastomosis) technique for use in autologous vein bypasses in crural vessels. This is a modified technique of conventional end-to-end spatulated anastomosis, which results in an asymmetric configuration of the anastomotic lateral walls. Using this modified technique the anastomosis’ area is greater and the opposite lateral anastomotic sites are always at different inclined levels. Therefore, in cases of intimal hyperplasia formation this asymmetric configuration may avoid the marked stenosis of the anastomosis and consequently the procedure's failure. In all cases, the asymmetric end-to-end anastomosis was used for revascularization of a single patent crural vessel. All procedures were successful and all target vessels remain patent for a median follow up of 15 months so far.