Surgical Treatment of a Giant Popliteal Artery Aneurysm (Transverse Diameter : 80 mm) via Both Medial and Posterior Approaches

Abstract

A 72-year-old man noticed discomfort in the popliteal fossa when bending his knees. CT angiography of the leg showed a giant popliteal aneurysm from the left distal superficial femoral artery (SFA) to the popliteal artery (PA). Surgery was performed under general anesthesia using a combined medial and posterior approach for aneurysm resection and graft replacement.
First, a medial approach was made from above and below the knee, and the distal SFA proximal to the popliteal aneurysm and distal PA were taped. Then, graft replacement was performed using an 8-mm vascular graft with distal end-to-side anastomosis and proximal end-to-end anastomosis. Next, through a posterior approach, the aneurysm was dissected as much as possible, and the PA distal to the aneurysm was ligated and dissected. With the patient in a supine position, again through a medial approach, the aneurysm was dissected proximally, and the inflow branches were dissected to complete the aneurysm resection.
The patient had a good postoperative course without leg ischemia. In patients with a giant popliteal artery aneurysm extending in the long-axis direction, a combined medial and posterior approach is very useful to ensure an adequate operative field and enable complete exposure of the aneurysm.