Giant popliteal aneurysm with deep vein thrombosis, foot drop and arteriomegali

Abstract

Popliteal artery aneurysms are the most common peripheral arterial aneurysms and are the second most common aneurysm after abdominal aortic aneurysms. Popliteal artery aneurysm affects mostly elderly men and atherosclerosis plays the major role in the aetiology of the disease. The management of popliteal artery aneurysms requires great care. Popliteal aneurysms are asymptomatic or otherwise present with intermittent claudication, compression symptoms in the popliteal fossa, distal embolisation and, rarely, rupture. We present a patient with a remarkably large popliteal aneurysm of 8×11 cm presenting as a popliteal swelling with foot drop and deep vein thrombosis and limb ischaemia. According to our thorough search of literature printed in English, it is one of the largest reported popliteal aneurysms with arteriomegaly, and its co-existing symptoms are unusual. The diagnostic investigations and treatment are presented.

Evaluation, Diagnosis and Management of Popliteal Artery Aneurysms: A Clinical Review

“…Despite the fact previous reports comparing repair of minimally symptomatic PAA's to asymptomatic disease did not show significantly different outcomes, elective repair anecdotally carries a better overall prognosis. This appears evident when comparing limb loss rates of < 1% in minimally symptomatic to asymptomatic patients versus 16 -43% if severe ischemia is present [3].…”

“…Size alone however, does not necessarily affect outcomes for PAA compared to aneurysms in other locations. This is likely due to the low risk of rupture but yet a significant thrombo-embolic risk that seems to have limited correlation to size [3,4]. A significant proportion of patients with PAA are asymptomatic, but the complication rate increases over time with 18 to 33% of PAA eventually developing symptoms of thrombo-embolism or mass effect.…”

“…4). A possible exception to this is the unstable elderly individual with a thrombosed PAA as a temporizing measure before definitive open excision of the compressing aneurysm [3]. Recent reports have emerged exploring endovascular intervention for PAA repair in both elective and emergency situations.…”

When size does not matter: a rare case of popliteal artery aneurysm presenting with foot drop and its endovascular management

“…Even though common peroneal neuropathy is the most common compressive mononeuropathy of the lower limb [4], it being due to PAA is rare as the two structures are relatively distant from each other. Therefore, the size of such PAA tends to be very large to cause symptoms of common peroneal nerve compression [5].…”

“…The general consensus across the literature regarding the indication for treatment of PAA includes asymptomatic PAA with diameter >2 cm, and all symptomatic PAA regardless of size [2, 5–7]. Until recently, it was thought that open repair was the mainstay of treatment in PAA due to the anatomical location of PAA at the knee joint, which may kink endografts during knee flexions, leading to increased risk of endograft migration, thrombosis, or even the fracture of the endograft [5].…”