Presentation and Management of Non-traumatic Giant Posterior Tibial Artery Aneurysm
Whitney Thorne, DO, Aaron Kulwicki, MD, Matt Recht, MD, Patrick Muck, MD, Brian Kuhn, MD.
TriHealth/Good Samaritan Hospital, Cincinnati, OH, USA.
DEMOGRAPHICS:
The patient is an 80 year old, Spanish speaking male, non-smoker, with BMI of 27.
HISTORY: The patient with multiple medical co-morbidities including chronic heart failure with EF 15%, atrial fibrillation, chronic renal insufficiency stage 3, presented with 2 month history of left calf claudication and leg pain. On physical exam he had palpable pulsatile mass in the left medial calf. He had previously undergone lower extremity venous and arterial dopplers which demonstrated a 6.6 x 4.9 cm aneurysm of the proximal posterior tibial artery. An angiogram was obtained and demonstrated a very large aneurysm arising a few centimeters distal to the origin of the posterior tibial artery without obvious arteriovenous fistula. Angiogram demonstrated runoff to the left foot via the anterior tibial and posterior tibial artery both run onto the foot.
PLAN:
Given the patient’s multiple co-morbidities, we planned for coil embolization of the posterior tibial artery.
DISCUSSION:
The patient was taken for angiogram which demonstrated widely patent peroneal, anterior tibial artery and posterior tibial artery with large aneurysm arising just distal to the takeoff. The posterior tibial artery was coiled just beyond the aneurysm with a 3 mm x 20 cm standard Penumbra®Ruby Coil and 3 mm x 15 cm soft Ruby Coil. The catheters were pulled back just proximal to the aneurysm and proximal posterior tibial aneurysm was coiled with 8 mm x 25 cm standard Ruby Coil and then packed with a POD6 50 cm. Completion angiogram demonstrated decreased flow within the posterior tibial artery and within the aneurysm, with continued patency of the anterior tibial and peroneal arteries. He was seen in follow up with resolution of his pulsatile mass and leg pain. 
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