Bilateral giant femoropopliteal artery aneurysms: a case report

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Abstract

Popliteal artery aneurysms (PAAs) are defined as localized dilatations of the popliteal artery over 2 cm in diameter or more than 150% of the normal arterial calibre [1]. True PAAs are mostly atherosclerotic in origin.

Although they are the most common peripheral artery aneurysm, their prevalence in men aged 65 to 80 years is only 1% [2]. PAAs are often bilateral [3,4]. An associated abdominal aortic aneurysm (AAA) is present in approximately 50% of patients [3,4].

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Popliteal artery aneurysms (PAAs) are defined as localized dilatations of the popliteal artery over 2 cm in diameter or more than 150% of the normal arterial calibre [1]. True PAAs are mostly atherosclerotic in origin.

Although they are the most common peripheral artery aneurysm, their prevalence in men aged 65 to 80 years is only 1% [2]. PAAs are often bilateral [3,4]. An associated abdominal aortic aneurysm (AAA) is present in approximately 50% of patients [3,4].

The most feared complication is the sudden development of acute ischemia caused by thrombosis of, or embolization from, the PAA. That is why it is often suggested that when a PAA has reached 2 cm in diameter, elective repair should be considered. Here we report a patient with two giant femoropopliteal aneurysms managed successfully in our institution.

Case presentation
An 82-year-old man who was a heavy smoker was referred to our hospital for the evaluation of bilateral huge femoropopliteal masses extending from the medial middle of the thigh to the knee. The patient complained of discomfort and bilateral impeded ambulation but no other particular symptoms were reported.

His past medical history included coronary artery disease being treated with medication, a known thoraco-abdominal aneurysm, prior abdominal aortic aneurysm repair and a right nephrectomy due to kidney donation for transplant to his daughter.

Physical examination revealed bilateral non-tender pulsatile masses. Both limbs had pedal pulses. His right knee was partially contracted.

The diagnosis of femoropopliteal aneurysms was suspected. Diagnostic assessment included multi-slice spiral computed tomography (CT) angiography which revealed two huge femoropopliteal aneurysms. The right one had a maximum diameter of 10.5 cm and the left a maximum diameter of 8.5 cm (Figure 1).

Figure 1. CT angiography results. A, B: 3D CT angiograms indicating the functional lumen of the two femoropopliteal aneurysms. C: CT scan indicating the maximum diameters of the popliteal aneurysms (10.5 cm on the right, 8.5 cm on the left).

Both aneurysms were resected following the same procedure, although there was a two-month interval between each resection. A 'classic' medial approach was used. The aneurysm was dissected carefully, incised longitudinally, the thrombi were evacuated, collaterals were oversewn from within the aneurysm, which finally was excised and replaced by an 8 mm PTFE femoropopliteal interposition graft (Figures 2 and 3). On both occasions, the postoperative course was uneventful. Two years later, arteriographic and Doppler examination showed patent bypass bilaterally.

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References
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