Popliteal artery aneurysm with popliteal artery entrapment syndrome: a case report and literature review.

BACKGROUND

Popliteal artery entrapment syndrome (PAES) is a rare anatomical anomaly that may rarely lead to secondary popliteal artery aneurysm (PAA). We present a case in which chronic extrinsic compression culminated in a giant PAA, highlighting the diagnostic workflow and surgical strategy.

CASE PRESENTATION: A 50-year-old man presented with a 2-year history of exercise-induced pain and numbness in the right lower limb. On examination, popliteal and distal pulses were absent. Duplex ultrasound showed a 4.1 cm saccular popliteal artery aneurysm (PAA) containing a 15 mm mural thrombus; CT angiography revealed moderate-to-severe stenosis of the proximal popliteal artery. Intra-operatively, the popliteal artery was found compressed and occluded by the medial head of the gastrocnemius, confirming popliteal artery entrapment syndrome; after partial myotomy to release the vessel, only the eccentric aneurysmal sac wall was excised while the macroscopically normal-appearing arterial wall was preserved, and the artery was reconstructed with an autologous small-saphenous-vein patch angioplasty.

DISCUSSION: PAES-induced PAA is uncommon; failure to recognise the underlying entrapment risks could lead to incorrect endovascular treatment. Open decompression combined with venous bypass remains the gold standard when the artery is structurally damaged.

CONCLUSION

Clinicians encountering an isolated PAA in a relatively young patient should actively exclude PAES. Timely surgical decompression and revascularisation can prevent thrombo-embolic complications and limb loss.