The first report of popliteal aneurysm stenting was by Marin et al when a Palmaz stent covered with polytetrafluoroethylene (PTFE) was used 5. Since then there have been reports of its use in treating popliteal aneurysms, with results equivalent to that of open technique. In a recent meta analysis, it was reported that endovascular technique offers similar medium term benefits as an open repair 6. There is only one randomised controlled trial that has reported comparable long-term results for endovascular repair compared with open repair 7. The position of the endograft behind the knee also makes the situation more complex. The flexion at the knee joint may possibly lead to kinking of the stent, predisposing to stent blockage/fracture 89. But careful endograft design and placement can help overcome this problem to an extent (Figure 1, 2). There are similar concerns about patients with femoral aneurysms who undergo endovascular stenting because of the movement at the hip joint. We have already reported the successful use of this technique in managing popliteal artery aneurysm in "hostile leg" 10. Further studies are warranted before it can be adopted as a treatment of first choice.

Endovascular stenting can also be used in treating arterio-venous fistulas/malformations and pseudoaneurysms in elective and emergency setting. This can be done by using covered stents or by coil embolization. There are many case reports in which it has been used to treat femoral 1112, popliteal 1314, tibial pseudoaneurysms 1516 and arterio-venous malformations 1718. In our experience this is a safe, minimally-invasive intervention which ensures an early return to work and a minimal hospital stay 19. The importance of endovascular stenting is quite significant in patients who develop pseudoaneurysms following orthopaedic procedures like total or partial knee replacement or during knee arthroplasty. These can present in both emergency and elective settings. Because of the hostile operative field, the endovascular approach offers a quick fix to the problem. Both covered stents and coils can be used depending upon the nature and extent of the arterial injury.

To avoid working in a difficult hostile operative field, this method is quite useful in managing patients with infectious arterio-venous fistulas/malformations. These are particularly common in intravenous drug abusers. We have already reported a case in which it was used to treat arterio-venous fistulas with a concurrent femoral pseudoaneurysm in an intra venous drug abuser, where open surgery was not possible due to the presence of a groin abscess (Figure 3, 4). Appropriate intravenous antibiotic cover is important in this scenario, to prevent graft infection 20.