A popliteal artery aneurysm presenting with ab extrinseco popliteal vein occlusion and compartment syndrome

INTRODUCTION: Aneurysms of popliteal artery are the most frequently reported aneurysm after abdominal aorta. An unusual presentation is compression to adjacent structure. CASE PRESENTATION: A 67 years old caucasian man presenting deep vein thrombosis signs to the right leg including functional impotence was admitted in emergency setting to Vascular Surgery Unit. A pulsing mass was present in the popliteal cave at inspection. The computed tomography angiography demonstrated a 53.2 mm popliteal artery aneurysm causing an ab extrinseco compression of the popliteal vein and a dislocation of popliteal nerve. A surgical open reconstruction with a reinforced Dacron graft was performed via a posterior approach. Patient was discharged on the fourth postoperative day with no functional impotence. At three and six months Doppler ultrasound followup both popliteal arterial graft and popliteal vein were patent. CONCLUSION: An unusual presentation of a popliteal artery aneurysm can be a popliteal compartment syndrome, especially in large aneurysms. Deep popliteal vein compression and/or popliteal nerve dislocation signs can rarely represent the clinical symptoms. The popliteal artery aneurysm repair is generally required to avoid a distal embolization and rupture. Through a surgical open repair was possible to achieve both popliteal cave decompression and the popliteal artery aneurysm repair.