Enlargement of previously ligated popliteal aneurysm causing venous bypass graft occlusion

A 72-year-old male patient presented with a thrombosed popliteal artery aneurysm measuring 15 x 8 cm 12 years following ligation and saphenous vein bypass grafting through a medial approach. The giant aneurysm, which had grown and compressed the previously functional vein bypass graft to the point of graft thrombosis, was causing a knee contracture that impeded ambulation. Resection via a posterior approach was accomplished without neurovascular compromise or the need for revascularization. This case underscores the value of aneurysm decompression in cases of large popliteal aneurysms to prevent further growth and attendant complications. Duplex surveillance of ligated popliteal aneurysms is warranted to exclude the possibility of future aneurysm expansion.