Ruptured Popliteal Artery Aneurysm Treated with Open Surgical Repair in a 91-Year-Old Woman: A Case Report

Popliteal artery aneurysms (PAAs) are the most common peripheral arterial aneurysms, although they remain relatively rare. Symptomatic PAAs generally present with limb ischemia due to distal embolization; however, rupture is extremely uncommon, and the optimal management has not yet been established. A 91-year-old woman presented with acute pain in the right leg and swelling of the popliteal fossa and posterior thigh. Computed tomography revealed a 45.1×44.7-mm right PAA. Emergency intervention was indicated, and open surgical repair via a posterior approach using a prosthetic graft was performed. Intraoperatively, a defect in the aneurysmal wall with active bleeding was identified, confirming rupture. The postoperative course was uneventful, and limb viability and graft patency were maintained for 3 years. Prosthetic graft interposition may be a feasible therapeutic option in carefully selected very elderly patients with ruptured PAA, even in the presence of limited distal runoff.