Endovascular repair of a ruptured giant popliteal artery aneurysm

An 88-year-old woman with hypertension, chronic vein insufficiency, and repeated cellulites in the right lower extremity was admitted to our hospital with a new episode of right leg inflammation and edema associated with fever and leukocytosis. Due to unilateral enlargement of the leg and D-simer levels of 1000 microg/mL, a concomitant deep venous thrombosis was suspected and ultrasonography was performed. Color duplex-scanning found normal flow in the right deep leg veins but revealed an 11-cm-diameter popliteal artery aneurysm. A computed tomography scan confirmed the diagnosis and revealed a large perianeurysmal hematoma, and angiography provided evidence of perianeurysmal bleeding. The patient was unfit for open surgery, so an endovascular approach under local anesthesia was elected. The aneurysm was successfully excluded with an endograft, and 15 months after surgery, the patient is alive and had an uneventful postoperative course.