Angiosarcoma after Popliteal Aneurysm Exclusion Surgery. A Systematic Review.

Area of Science:

• Vascular surgery
• Surgical oncology
• Diagnostic imaging

Background:

• Popliteal artery aneurysms (PAAs) are common, with expansion after exclusion surgery a frequent occurrence.
• Popliteal angiosarcoma is a rare malignancy, often diagnosed late, particularly following PAA repair.
• This study investigates a case of popliteal angiosarcoma misdiagnosed as aneurysm expansion and reviews existing literature.

Approach:

• A secondary popliteal aneurysmorrhaphy was performed for a symptomatic aneurysm expansion 9 years post-bypass.
• Postoperative complications led to pathological analysis revealing angiosarcoma.
• A systematic literature review was conducted on popliteal artery angiosarcomas, focusing on primary and secondary (post-surgery) cases.

Key Points:

• This case, along with literature, highlights 13 instances of popliteal angiosarcomas, with 11 secondary to PAA surgery.
• Most secondary cases were initially misdiagnosed as aneurysm expansion after bypass.
• A significant mortality rate (8/13) was observed within the first year post-diagnosis.

Conclusions:

• A potential association exists between popliteal angiosarcoma and prior PAA exclusion surgery, though causality is unproven.
• Angiosarcoma must be considered in the differential diagnosis for atypical PAA expansion or post-surgical complications.
• Early diagnosis through systematic imaging and pathology, and potentially utilizing a posterior surgical approach, may improve outcomes.