Residual Popliteal Aneurysm Perfusion Leading to Embolic Complications: A Case Report
Introduction: Surgical management of popliteal artery aneurysms has been described for half a century. Long term development of the excluded aneurysm sac in the popliteal segment however remains widely unknown, with only a few small series describing outcomes. Residual aneurysm perfusion has the pot...
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Elsevier
2024-01-01
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| Series: | EJVES Vascular Forum |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666688X2400090X |
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| author | Matteo Giardini Christoph A. Binkert Thomas R. Wyss |
| author_facet | Matteo Giardini Christoph A. Binkert Thomas R. Wyss |
| author_sort | Matteo Giardini |
| collection | DOAJ |
| description | Introduction: Surgical management of popliteal artery aneurysms has been described for half a century. Long term development of the excluded aneurysm sac in the popliteal segment however remains widely unknown, with only a few small series describing outcomes. Residual aneurysm perfusion has the potential to lead to serious complications. Report: A 63 year old man presents with skin and soft tissue necrosis of the right calf two years after proximal and distal aneurysm ligation and great saphenous vein bypass for a popliteal artery aneurysm. Computed tomography and magnetic resonance angiography show perfusion of the excluded aneurysm as well as extensive necrosis of the gastrocnemius muscle. Direct angiography of the aneurysm demonstrated retrograde aneurysm perfusion due to insufficient distal ligation with recurrent micro-embolisation to the calf via geniculate arteries. Coiling of the geniculate arteries was performed, plugging the connection to the tibiofibular trunk and embolisation of the aneurysm sac. After the intervention, no flow was seen in the aneurysm sac and the patient made full recovery. Discussion: Residual aneurysm sac perfusion can lead to complications long after successful aneurysm exclusion. Follow-up after surgery of popliteal aneurysms should include observation of the excluded aneurysm sac with control of residual blood flow. For persistent sac perfusion, aneurysm enlargement or symptoms, further treatment should be considered. Surgical aspects such as complete transection of the artery after aneurysm ligation or end to end anastomosis of the bypass may be considered, to prevent such complications. |
| format | Article |
| id | doaj-art-e5ba965df07647f5bd4f735c4ad334f4 |
| institution | OA Journals |
| issn | 2666-688X |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EJVES Vascular Forum |
| spelling | doaj-art-e5ba965df07647f5bd4f735c4ad334f42025-08-20T02:35:47ZengElsevierEJVES Vascular Forum2666-688X2024-01-01621410.1016/j.ejvsvf.2024.05.010Residual Popliteal Aneurysm Perfusion Leading to Embolic Complications: A Case ReportMatteo Giardini0Christoph A. Binkert1Thomas R. Wyss2Department of Interventional Radiology and Vascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland; Corresponding author. Department of Interventional Radiology and Vascular Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland.Department of Interventional Radiology and Vascular Surgery, Kantonsspital Winterthur, Winterthur, SwitzerlandDepartment of Interventional Radiology and Vascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland; Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandIntroduction: Surgical management of popliteal artery aneurysms has been described for half a century. Long term development of the excluded aneurysm sac in the popliteal segment however remains widely unknown, with only a few small series describing outcomes. Residual aneurysm perfusion has the potential to lead to serious complications. Report: A 63 year old man presents with skin and soft tissue necrosis of the right calf two years after proximal and distal aneurysm ligation and great saphenous vein bypass for a popliteal artery aneurysm. Computed tomography and magnetic resonance angiography show perfusion of the excluded aneurysm as well as extensive necrosis of the gastrocnemius muscle. Direct angiography of the aneurysm demonstrated retrograde aneurysm perfusion due to insufficient distal ligation with recurrent micro-embolisation to the calf via geniculate arteries. Coiling of the geniculate arteries was performed, plugging the connection to the tibiofibular trunk and embolisation of the aneurysm sac. After the intervention, no flow was seen in the aneurysm sac and the patient made full recovery. Discussion: Residual aneurysm sac perfusion can lead to complications long after successful aneurysm exclusion. Follow-up after surgery of popliteal aneurysms should include observation of the excluded aneurysm sac with control of residual blood flow. For persistent sac perfusion, aneurysm enlargement or symptoms, further treatment should be considered. Surgical aspects such as complete transection of the artery after aneurysm ligation or end to end anastomosis of the bypass may be considered, to prevent such complications.http://www.sciencedirect.com/science/article/pii/S2666688X2400090XAneurysm perfusionBypass surgeryPopliteal aneurysmVascular surgery |
| spellingShingle | Matteo Giardini Christoph A. Binkert Thomas R. Wyss Residual Popliteal Aneurysm Perfusion Leading to Embolic Complications: A Case Report EJVES Vascular Forum Aneurysm perfusion Bypass surgery Popliteal aneurysm Vascular surgery |
| title | Residual Popliteal Aneurysm Perfusion Leading to Embolic Complications: A Case Report |
| title_full | Residual Popliteal Aneurysm Perfusion Leading to Embolic Complications: A Case Report |
| title_fullStr | Residual Popliteal Aneurysm Perfusion Leading to Embolic Complications: A Case Report |
| title_full_unstemmed | Residual Popliteal Aneurysm Perfusion Leading to Embolic Complications: A Case Report |
| title_short | Residual Popliteal Aneurysm Perfusion Leading to Embolic Complications: A Case Report |
| title_sort | residual popliteal aneurysm perfusion leading to embolic complications a case report |
| topic | Aneurysm perfusion Bypass surgery Popliteal aneurysm Vascular surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2666688X2400090X |
| work_keys_str_mv | AT matteogiardini residualpoplitealaneurysmperfusionleadingtoemboliccomplicationsacasereport AT christophabinkert residualpoplitealaneurysmperfusionleadingtoemboliccomplicationsacasereport AT thomasrwyss residualpoplitealaneurysmperfusionleadingtoemboliccomplicationsacasereport |