Urgent endovascular treatment of a ruptured tibioperoneal pseudoaneurysm in Behçet's disease

Behçet's disease is an autoimmune, systemic vasculitis disease that is characterized by oral aphthous and genital ulcerations and ocular lesions. Vascular manifestations in the form of aneurysms are the main predictors of mortality and morbidity in such cases. Normally, these aneurysms are located in the pulmonary arteries, the aorta, carotid, subclavia, and the femoropopliteal sector. Open surgery presents a maximum complication rate of 50%, principally in the form of anastomotic pseudoaneurysms.

We report the case of a 41-year-old man who was diagnosed with Behçet's disease 3 years before, and attended the emergency department after a 10-day history of pain and an infragenicular swelling edema in the right limb, without any previous record of trauma.

An initial vascular exploration revealed a pusatile mass in the infrapopliteal region and absence of the posterior tibial pulse in the right limb. The rest of the exploration did not reveal any alterations. A Doppler ultrasound scan showed a ruptured infrapopliteal pseudoaneurysm. An emergency, selective arteriography of the popliteal artery was performed by using a contralateral femoral access approach, and a ruptured tibioperoneal pseudoaneurysm was embolized with three 5-mm metallic coils (Cook). The patient was discharged after 4 days and in the 2 years since then has remained asymptomatic.

Aneurysms of the distal vessels in Behçet's disease are very infrequent and each case should be evaluated on an individual basis. Endovascular treatment is a good therapeutic alternative.