Asymptomatic ruptured giant popliteal aneurysm

Abstract

An 84-year-old male presented with two large masses on the left leg and a large mass on the right leg. The patient reported that the two masses on the left leg had been there for approximately 2 years. He did not report any significant symptoms related to the masses on lower extremities other than dislike for the size and concern for “impending rupture.” On examination of the left leg, the patient had two large, nonpulsatile masses on the medial aspect (A). Masses were soft, nontender, and had no Doppler signal. His pulse examination demonstrated a left femoral pulse with no distal pulses. There were biphasic Doppler signals in the left dorsal pedal and posterior tibial positions with an ankle-brachial index of 0.8. The right leg had a large, pulsatile mass on the medial thigh. There were palpable femoral and popliteal pulses with an anklebrachial index of 0.9. Computed tomography angiogram of the left lower extremity showed a multilobulated mass (21.7 18 40 cm) extending from mid-thigh to mid-calf, consistent with a contained rupture of a giant popliteal artery aneurysm with thrombosis. On the right, there was a giant popliteal artery aneurysm (8.5 9.7 16.6 cm) with significant intraluminal thrombus with patent outflow vessels (B). Angiogram of the left leg showed reconstitution of the distal popliteal artery and two-vessel runoff to the left foot (C). Exploration of the left leg was performed, and both masses were consistent with old hematomas within a pseudocapsule (D). The masses were evacuated, and revascularization was not necessary due to adequate collateral blood flow. Seven days after his initial surgery, he was returned to the operating room for ligation and bypass of his right popliteal artery aneurysm with nonreversed greater saphenous vein. Popliteal artery aneurysms are defined as dilation of the popliteal artery over 2 cm in diameter. Popliteal artery aneurysms are most commonly symptomatic secondary to a thromboembolic event, acute rupture, or compression of adjacent structures. This case is unusual in that the patient was relatively asymptomatic upon presentation and did not require revascularization of the left leg. Only one similar case has been reported in the literature.