Management of true dorsalis pedis aneurysm

Background: True aneurysms of the dorsalis pedis artery (DPA) are a rare vascular condition. The pathophysiology of DPA aneurysms remains poorly understood, and there is no established consensus on indications for intervention or the optimal treatment approach. Methods: A review of the existing literature highlights a variety of treatment strategies. In this report, we describe the management of a 78-year-old woman who presented with a pulsatile mass on the dorsum of her left foot. Results: Diagnostic imaging and surgical exploration confirmed a true DPA aneurysm with mural thrombus, and she underwent a successful resection with end-to-end anastomosis that resulted in excellent distal perfusion. This case and review of the literature underscore the importance of individualized surgical decision making based on anatomical and functional considerations. Conclusion: The key takeaway is that early surgical intervention, including reconstruction when appropriate, is recommended for DPA aneurysms to prevent potential complications such as distal embolization and ischemia.