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Endovascular Management For A Rupture Of A Previously Ligated Popliteal Artery Aneurysm Following Redo Revascularization: A Case Report
Hayden R. Caudill, DO, Catherine Go, MD, Mohammad Eslami, MD, MPH, MBA, Andrew K. Lee, MD.
Charleston Area Medical Center, Charleston, WV, USA.
DEMOGRAPHICS Popliteal artery aneurysms (PAA) are the most common peripheral aneurysm with an incidence of 1% in the general population. PAAs commonly present with ischemic symptoms as rupture is quite rare (2% incidence). In this case report, we discuss a unique rupture of a previously bypassed and ligated PAA after a redo right lower extremity (RLE) bypass.
HISTORY 76-year-old man who originally presented in 2016 with RLE acute-on-chronic limb ischemia. He was diagnosed with a 1.4 cm thrombosed PAA with 2-vessel runoff. He underwent a superficial femoral artery to below-knee popliteal artery bypass with great saphenous vein with ligation of the PAA. During follow-up in 2023, he developed rest pain of his RLE and his previous bypass had occluded. He underwent a common femoral artery (CFA) to PT artery bypass with prosthetic graft. Two months post-procedure, he presented to the hospital for RLE swelling and pain. Duplex evaluation showed a 3.18 x 4.03 cm mass with arterial flow in the popliteal fossa. CTA showed patent CFA-PT bypass and contrast extravasation from the native, thrombosed PAA in the popliteal fossa.
PLAN The patient underwent angiogram and was noted to have a rupture of the previously thrombosed PAA with active extravasation from a collateral vessel from the distal PT artery filling retrograde. The patient underwent coil embolization of the major feeding vessel. All anti-platelets and anti-coagulation were held post-operatively, and the patient’s symptoms improved post-intervention on his follow-up visit.
DISCUSSION This case describes a unique situation in which a thrombosed PAA previously treated with aneurysm exclusion/ligation and bypass, not only grew substantially in size, but became symptomatic with rupture two months after a redo revascularization. Rupture of a PAA is rare as evidenced by the paucity of literature surrounding this complication. However, this appears to be the first report of a ruptured PAA after redo revascularization following a previous bypass/ligation 7 years prior. This also highlights the importance of duplex evaluation post-operatively to evaluate collateral feeding vessels. This case demonstrates the presentation, diagnosis, and successful utilization of endovascular evaluation and intervention with coil embolization as a treatment modality for this clinical scenario.
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