Bilateral popliteal aneurysm as a result of vascular type IV entrapment in a young patient: A report of an exceptional case

Abstract

Popliteal artery entrapment syndrome is recognized as a cause of claudication and arterial occlusion in young patients. Aneurysmal degeneration is a reported but rare complication. We present the case of a young male patient with large bilateral popliteal aneurysms due to symptomatic anatomic entrapment. The left aneurysm was acutely thrombosed, and urgent bypass surgery was required. The contralateral aneurysm was resected by a posterior approach and replaced with an autologous vein graft. Type IV popliteal entrapment by a fibrous band independent of the gastrocnemius muscle was diagnosed during surgery and divided. Early detection of popliteal entrapment is highly important to prevent the development of this serious complication.

Case report and literature review of popliteal artery entrapment syndrome

“…5 Symptoms often occur as a result of arterial wall degeneration and compression, depending on the degree of compression, magnitude of forces acting on the popliteal artery, and duration of compression. 6 If untreated, the compression mechanism frequently results in deterioration of the popliteal artery which may progress to an occlusion. 7 Recurrent popliteal artery compression can cause intimal damage, thrombosis, 8 distal embolization, post-stenotic dilation, and formation of true aneurysm, 6 which makes accurate diagnosis and timely management imperative.…”

“… 6 If untreated, the compression mechanism frequently results in deterioration of the popliteal artery which may progress to an occlusion. 7 Recurrent popliteal artery compression can cause intimal damage, thrombosis, 8 distal embolization, post-stenotic dilation, and formation of true aneurysm, 6 which makes accurate diagnosis and timely management imperative. 7 Unfortunately, delayed diagnosis due to young patient age and lack of atherosclerotic risk factors is common, making progressive deterioration more frequent.…”

Popliteal artery entrapment syndrome as a cause of failed treatment of a false popliteal aneurysm

“…However, PAES might still be misdiagnosed, as shown in our case and other reports. 3 , 12 MRI provides better resolution of soft tissues, and it can be helpful for the recognition of abnormal musculotendinous structures and the diagnosis of PAES. 13 Nevertheless, the diagnosis can still be missed by MRI, especially the diagnosis of type IV PAES.…”

“…Aneurysms can also develop and manifest as a pulsatile mass and chronic or acute limb ischemia. 3 , 4 False popliteal aneurysms are rare but can also be seen in patients with PAES. 5 , 6 We herein present a rare case of a false PAA associated with PAES.…”