Ruptured Popliteal Artery Aneurysm

Keywords

popliteal artery - aneurysm - imaging - aging - endovascular

An 88-year-old female, with arterial hypertension, was admitted to our hospital for onset of acute pain and swelling behind her left knee. There was no history of trauma. Physical examination revealed a palpable and pulsatile mass in the upper popliteal fossa. Left ankle brachial index was 0.8 (normal range: 0.9–1.2). Multidetector computed tomography of left lower limb, on axial and sagittal volume rendering technique reconstruction, revealed a voluminous popliteal artery aneurysm (4.1 cm; arrowhead) with partial aneurysm sac thrombosis and signs of contained rupture ([Fig. 1A, B]). She was felt to be a candidate for an urgent percutaneous endovascular approach.

Fig. 1 A voluminous popliteal artery aneurysm (arrowhead) with partial aneurysm sac thrombosis and signs of contained rupture. VRT, volume rendering technique.

Intraprocedural diagnostic digital subtraction angiography confirmed left popliteal artery aneurysm ([Fig. 2]; arrowhead). A covered stent was deployed into the left popliteal artery segment with consequent aneurysm sac exclusion ([Fig. 3]). The patient's symptoms resolved after the procedure with an uneventful postoperative course.

Fig. 2 Intraprocedural diagnostic digital subtraction angiography confirmed left popliteal artery aneurysm (arrowhead).

Fig. 3 A covered stent was deployed into the left popliteal artery segment with consequent aneurysm sac exclusion.

Predischarge and follow-up ultrasound color Doppler confirmed thrombosis of the treated left popliteal aneurysm sac and stent lumen patency.

Ruptured popliteal artery aneurysm is an uncommon event in an uncommon disease.[1] Multidetector computed tomography in urgent cases is the diagnostic imaging of choice to evaluate aneurysm anatomy and possible complications, as well as for planning treatment approach.[1] [2] In cases of ruptured popliteal artery aneurysm, as in our patient, with partial thrombosis and good run-off blood flow to the foot, an endovascular approach is indicated.[2] Endovascular deployment of a covered stent to exclude the popliteal artery aneurysm is a less invasive procedure compared with a conventional surgical approach.[3]

• References

• 1 Cervin A, Ravn H, Björck M. Ruptured popliteal artery aneurysm. Br J Surg 2018; 105 (13) 1753-1758
• 2 Björck M, Earnshaw JJ, Acosta S. et al; Esvs Guidelines Committee. Editor's choice - European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia. Eur J Vasc Endovasc Surg 2020; 59 (02) 173-218
• 3 Rossi UG, Santuari D, Dallatana R, Cariati M. Use of iliac branch device for endovascular treatment for abdominal aorta aneurysm with small diameter neck. Aorta (Stamford) 2017; 5 (06) 181-183