A Unique Case Of A Giant Popliteal Artery Aneurysm Presenting As Popliteal Mass
DOI:
https://doi.org/10.48729/pjctvs.390Keywords:
popliteal artery aneurysm, open repair, posterior approachAbstract
Introduction: Popliteal artery aneurysms (PAA) can be very challenging, especially in cases of very large PAAs, with a minimal number of case reports published in the literature.Methods: This is a case report of a 68-year-old male patient with hypertension, hyperlipidemia, diabetes, and schizophrenia who was found to have a giant (10x8x6cm) partially thrombosed PAA, treated with interposition polytetrafluoroethylene (PTFE) graft via a posterior approach.
Results: Under general anesthesia, the patient was placed in a prone position, and an extended lazy "S" incision was made on the popliteal fossa. After obtaining proximal and distal exposure, the aneurysm sac was skeletonized, preserving the popliteal vein and the tibial nerve. After proximal and distal control was obtained, the patient was systemically heparinized, and the aneurysm sac was opened. Some genicular branches were ligated inside the aneurysm, and part of the aneurysm sac was excised. A 7 mm PTFE graft was used for reconstruction in an end-to-end fashion. Suction drains were placed in the popliteal space, and the fascia and skin were approximated. The patient was discharged home on the 2nd postoperative day on aspirin and statin with ultrasound surveillance. The patient has remained asymptomatic during follow-up with a patent graft.
Conclusions: Open surgical repair constitutes the gold standard of care for huge PAAs to prevent distal thromboembolic events and mass pressure effects from the aneurysm. Documentation of additional experience with open repair of huge PAAs would be beneficial and could help clinical decision-making.
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References
Antonello M, Frigatti P, Battocchio P, Lepidi S, Dall'Antonia A, Deriu GP, et al. Endovascular treatment of asymptomatic popliteal aneurysms: 8-year concurrent comparison with open repair. J Cardiovasc Surg (Torino). 2007;48(3):267-74.
Aulivola B, Hamdan AD, Hile CN, Sheahan MG, Skillman JJ, Campbell DR, et al. Popliteal artery aneurysms: a comparison of outcomes in elective versus emergent repair. J Vasc Surg. 2004;39(6):1171-7.
Vogel TR, Dombrovskiy VY, Carson JL, Haser PB, Lowry SF, Graham AM. Infectious complications after elective vascular surgical procedures. J Vasc Surg. 2010;51(1):122-9; discussion 9-30.
Martelli E, Ippoliti A, Ventoruzzo G, De Vivo G, Ascoli Marchetti A, Pistolese GR. Popliteal artery aneurysms. Factors associated with thromboembolism and graft failure. Int Angiol. 2004;23(1):54-65.
Thompson MM, Bell PR. ABC of arterial and venous disease. Arterial aneurysms. Bmj. 2000;320(7243):1193-6.
Tsilimparis N, Dayama A, Ricotta JJ, 2nd. Open and endovascular repair of popliteal artery aneurysms: tabular review of the literature. Ann Vasc Surg. 2013;27(2):259-65.
Verikokos C, Karaolanis G, Doulaptsis M, Kouvelos G, Kotzadimitriou A, Palla VV, et al. Giant popliteal artery aneurysm: case report and review of the literature. Case Rep Vasc Med. 2014;2014:780561.
Nakashima M, Kobayashi M. Open Repair of a Giant Popliteal Artery Aneurysm Presenting with Nerve Compression Symptoms. Vasc Specialist Int. 2021;37(1):37-40.
Beuschel B, Nayfeh T, Kunbaz A, Haddad A, Alzuabi M, Vindhyal S, et al. A systematic review and meta-analysis of treatment and natural history of popliteal artery aneurysms. J Vasc Surg. 2022;75(1s):121S-5S.e14.
Cho T, Iwaki H, Masuda M. Extended posterior approach for huge popliteal aneurysm extended to superficial femoral artery. SAGE Open Med Case Rep. 2018;6:2050313x17752770.
Cho M, Ahn S, Min SI, Min SK. Ruptured giant popliteal artery aneurysm. J Vasc Surg Cases Innov Tech. 2017;3(4):201-2.
Jadhav S, Sanagar S, Kaushik S, Munde H. Giant Popliteal Artery Aneurysm in a Teenager: An Unusual Occurrence. Korean J Thorac Cardiovasc Surg. 2019;52(2):116-8.
Farber A, Angle N, Avgerinos E, Dubois L, Eslami M, Geraghty P, et al. The Society for Vascular Surgery clinical practice guidelines on popliteal artery aneurysms. J Vasc Surg. 2022;75(1s):109s-20s.
Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517-38.
Muir D, Kulkarni SR. Successful Endovascular Repair of a Ruptured Popliteal Artery Aneurysm: A Case Report and Literature Review. Case Rep Vasc Med. 2020;2020:8745780.
Tian Y, Yuan B, Huang Z, Zhang N. A Comparison of Endovascular Versus Open Repair of Popliteal Artery Aneurysms: An Updated Meta-Analysis. Vasc Endovascular Surg. 2020;54(4):355-61.
Phair A, Hajibandeh S, Hajibandeh S, Kelleher D, Ibrahim R, Antoniou GA. Meta-analysis of posterior versus medial approach for popliteal artery aneurysm repair. J Vasc Surg. 2016;64(4):1141-50.e1.
Beseth BD, Moore WS. The posterior approach for repair of popliteal artery aneurysms. J Vasc Surg. 2006;43(5):940-4; discussion 4-5.
Grip O, Mani K, Altreuther M, Bastos Gonçalves F, Beiles B, Cassar K, et al. Contemporary Treatment of Popliteal Artery Aneurysms in 14 Countries: A Vascunet Report. Eur J Vasc Endovasc Surg. 2020;60(5):721-9.
Chang H, Veith FJ, Rockman CB, Siracuse JJ, Jacobowitz GR, Cayne NS, et al. Comparison of Outcomes for Open Popliteal Artery Aneurysm Repair Using Vein and Prosthetic Conduits. Ann Vasc Surg. 2021;75:69-78.
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