Continued Growth of a Popliteal Aneurysm Following Surgery

Case Report period. Duplex scan of the popliteal fossa demonstrated that despite surgery the popliteal aneurysm A 77-year-old male presented with sudden onset of had continued to expand and now measured 11 cm in maximum diameter. No flow was seen within the ischaemic pain in his right foot. He had no past history of intermittent claudication, ischaemic heart disease aneurysm and appearances suggested popliteal vein compression which was confirmed with computerized or atrial fibrillation. His vascular risk factors included a recent diagnosis of type 2 diabetes mellitus and he tomography. The left popliteal aneurysm was decompressed surgically by incision and evacuation of had stopped smoking 26 years previously. On examination his right forefoot was dusky and thrombus. Inspection of the lining of the aneurysm showed non-pulsatile backbleeding from the luminal cold to palpation but all the pulses in that leg were palpable. The clinical diagnosis of popliteal aneurysm aspect of the proximal popliteal artery. The aneurysm was fed via collaterals around the knee that were was confirmed by ultrasound. The diagnosis was trash foot due to emboli from a popliteal aneurysm and controlled by underrunning sutures. Exploration of the proximal anastomosis revealed that there was no intravenous heparin started. The right-sided aneurysm was ligated proximally pulse or Doppler shift signal in the superficial femoral artery immediately distal to the intact ligature. and distally and circulation restored using reversed saphenous vein. The patient recovered well from The patient made good postoperative progress an on follow-up the lower limb swelling had improved surgery. Ultrasound also demonstrated a 2.8 cm left popliteal aneurysm containing thrombus but the abat 1 month. Duplex follow-up confirms a functioning graft with no flow in the aneurysm and no increase dominal aorta was normal calibre. In 1993 the left-sided aneurysm was operated on in size. after a brief history of ischaemic symptoms. The aneurysm ligated proximally at the distal superficial femoral artery and distally at the below knee popliteal artery. A left-sided femoro to below knee popliteal Discussion artery bypass was performed using autologous saphenous vein. Again the patient made an uneventful Popliteal artery diameter increases with age, sex and postoperative recovery. body size and is considered aneurysmal if it measures Six years later the patient was admitted with a 3 1.5 times the size of normal proximal artery or if its week history of swelling of the left calf and thigh. A external diameter exceeds 2.0 cm. Aneurysms of the deep vein thrombosis was diagnosed on venography popliteal artery account for 70% of peripheral anwith thrombus extending from the calf veins into the eurysms and only aneurysmal dilatation of the abpopliteal vein. Despite anticoagulation and support dominal aorta is more common. In Western nations hoisery his symptoms did not resolve over a 2-month the conditions is being recognized more frequently but it has been estimated that only four or five cases a year will present to any major vascular centre. ∗ Correspondence to: D. R. Lewis, Specialist Registrar, Department of Surgery, Torbay Hospital, Torquay, Devon TQ2 7AA, U.K. Aneurysm formation in the popliteal artery may be