A Case of Giant Idiopathic Posterior Tibial Pseudoaneurysm Treated with Revascularization

Abstract

Posterior tibial artery aneurysms are extremely rare, and most of them are iatrogenic or traumatic pseudoaneurysms. I have experienced a case in which revascularization was performed using the great saphenous vein for an idiopathic posterior tibial artery pseudoaneurysm for which the extrinsic cause was not clear, and we report this including a review of the literature. The patient was a 74-year-old man. He had been aware of swelling in his left lower leg for three months before coming to the hospital. He was diagnosed with a left posterior tibial artery aneurysm and was referred to our department. The left posterior tibial artery aneurysm was approximately 41×70 mm in size and extremely large. Due to the large size of the aneurysm, it was difficult to reconstruct the aneurysm with direct anastomosis, and a great saphenous vein graft was used to reconstruct the blood circulation. Postoperative echocardiograms of the lower limbs showed the blood flow in the reconstructed graft, and ankle brachial index and skin perfusion pressure did not change before and after the surgery. In this case, revascularization with the great saphenous vein was required due to the huge posterior tibial artery aneurysm, but revascularization can be performed with relatively minimal incisions, and the postoperative course progressed without any symptoms of lower extremity artery occlusion and any trouble of wound. The blood flow to the distal side of the posterior tibial artery was patent before surgery, and aggressive surgical revascularization should be considered to maintain long-term blood flow in the peripheral blood vessels of the lower extremities.