A 42-year-old man was admitted to hospital complaining of a pulsatile swelling in the anterior compartment of his left lower leg. One month earlier, he had been stabbed in that area with a small knife but had not sought medical attention at that point. His medical history included diabetes mellitus and a right below knee amputation. The clinical examination revealed a large swelling in the anterior compartment of the left lower leg. All pulses were palpable in the left leg except the dorsalis pedis. Arterial duplex imaging and an angiogram demonstrated two large false aneurysms arising from the anterior and posterior wall of left anterior tibial artery (A and Cover). Through an antegrade approach by way of the left common femoral artery, a 6F sheath was negotiated into the left popliteal artery. Over a 0.035-inch wire, selective catheterization of the anterior tibial artery was undertaken, and the catheter was placed distal to the false aneurysm. Intra-arterial heparin was administered (4000 units). The catheter was exchanged for a 0.0140-inch wire, and a 3-mm × 19-mm covered stent (JOSTENT Graft, Abbott Vascular, Abbott Park, Ill) was placed at the site of the false aneurysm. Residual filling of the aneurysm was demonstrated. A further 3.5-mm × 19-mm overlapping covered stent was placed and achieved complete exclusion of the aneurysm (B and C). The patient was discharged the next day without complication. At follow-up 6 weeks later, the mass in the left anterior compartment was nonpulsatile and reducing in size. Both pedal pulses were palpable. Covered stents are increasingly being used to treat false aneurysms at a number of sites.1Saad N.E. Saad W.E. Davies M.G. Waldman D.L. Fultz P.J. Rubens D.J. Pseudoaneurysms and the role of minimally invasive techniques in their management.Radiographics. 2005; 25: S173-S189Crossref PubMed Scopus (294) Google Scholar To our knowledge, there has only been one other report of the use of a covered stent to treat an anterior tibial artery false aneurysm.2De Roo R.A. Steenvoorde P. Schuttevaer H.M. Den Outer A.J. Oskam J. Joosten P.P. Exclusion of a crural pseudoaneurysm with a PTFE-covered stent-graft.J Endovasc Ther. 2004; 11: 344-347Crossref PubMed Scopus (30) Google Scholar In that instance, the stent graft was reported to be patent at 1 year. Other options in this patient included ligation of the false aneurysm alone or ligation and anterior tibial bypass. The technical ease of treatment and quick recovery all favor an endovascular approach. The patency of stent grafts placed at this site is presently unclear and requires further study. Download .jpg (.41 MB) Help with jpg files Cover Image