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Ruptured Popliteal Aneurysms: A Case Series and Systematic Review
Aseel Abuduruk1, Adel Abdallah1, Philip Stather2
1Department of Vascular Surgery, Norfolk and Norwich University Hospital, Norwich, UK.
Annals of Vascular Surgery
|March 7, 2025
Summary
Ruptured popliteal artery aneurysms are often misdiagnosed as DVT, delaying treatment and increasing risks of limb loss and mortality. Early identification of risk factors is crucial for timely intervention in these rare cases.
Area of Science:
- Vascular Surgery
- Diagnostic Radiology
- Emergency Medicine
Background:
- Ruptured popliteal artery aneurysm (rPAA) is a rare vascular emergency, accounting for 2.5% of operated popliteal artery aneurysms (PAA).
- Patients often present with unilateral leg pain and swelling, leading to misdiagnosis and referral to clinics for conditions like deep venous thrombosis (DVT).
- Delayed diagnosis of rPAA significantly impacts patient outcomes, including limb salvage and survival rates.
Purpose of the Study:
- To evaluate the relationship between the initial diagnostic pathway for ruptured popliteal artery aneurysms and patient outcomes.
- To assess the influence of diagnostic delays on limb loss and amputation-free survival (AFS) in rPAA cases.
- To identify risk factors and clinical criteria for early diagnosis of rPAA.
Main Methods:
- Retrospective review of patients diagnosed with rPAA between 2007 and 2023 referred to vascular surgery.
- Data collection included initial diagnosis, time to definitive diagnosis, limb loss, and amputation-free survival (AFS).
- Systematic review following PRISMA guidelines to analyze reported cases of rPAA in existing literature.
Main Results:
- In a local cohort, 6 out of 40 complicated PAAs (15%) were rPAAs; 2 cases were initially diagnosed as DVT, delaying diagnosis by up to 6 days.
- Local rPAA cases resulted in 33.3% amputation-free survival (AFS), with 2 major limb amputations and 2 in-hospital mortalities.
- Literature review of 134 rPAA cases revealed missed diagnoses in 78.89%, with high 30-day (13.22%) and 90-day (27.68%) mortality rates.
Conclusions:
- Misdiagnosis of ruptured popliteal artery aneurysms is frequent, leading to delayed diagnosis and intervention.
- High rates of mortality and major amputation underscore the severity of rPAA.
- Early identification of risk factors and specific clinical criteria are essential for timely diagnosis and improved outcomes in rPAA patients.
