Abstract
A 60-year-old man was referred to our hospital because of sudden onset of severe pain in the right leg, which appeared pale and exhibited sensory loss and motor weakness. Duplex ultrasonography could not detect a pulse in the right posterior tibial artery and dorsal pedis artery. Pulsatile masses were identified in bilateral popliteal fossae. A plain computed tomography (CT) scan showed bilateral popliteal artery aneurysms (PAAs), and the right-side one of 33 mm in diameter was located in the popliteal space. An enhanced magnetic resonance angiography (MRA) revealed almost total occlusion of the below-knee arteries with very low-grade collateral flow. The right PAA with acute ischemia (grade IIb according to Rutherford’s classification) was indicated for emergency surgical treatment. A posterior approach with the patient in the prone position was selected for aneurysmectomy with thromboembolectomy and prosthetic graft replacement. The below-knee trifurcation flow to the ankle was confirmed by intraoperative arteriography. The patient was discharged from the hospital on foot. When an emergency operation is adopted for severe acute ischemia caused by PAA, a quick decision must be made regarding the surgical approach, which can include a medial approach with bypass or a posterior approach with graft replacement. Our choice of operation was based on a plain CT image, obtained to confirm the shape of aneurysm, and an enhanced MRA to evaluate peripheral blood flow. Although this issue remains controversial, the present report may be of some help toward making such decisions.
