Endovascular management of a ruptured popliteal artery aneurysm in a patient with Behçet's disease

Abstract

Purpose: Popliteal artery aneurysms are the most common peripheral arterial aneurysms. One of their etiologies is Behçet's disease. Discussions about the best way to treat popliteal artery aneurysms in BD are still ongoing in the literature. We report a case of a patient that presented with a ruptured right popliteal artery aneurysm that had a successful endovascular treatment and was followed up for 36 months. Case report: Our patient was a 59-year-old male with a medical history of hypertension, diabetes mellitus and Behçet's disease. He presented with acute limb ischemia of the right lower limb. Doppler ultrasound showed a ruptured large aneurysm of 7,2 × 5,1 cm in size in the right popliteal fossa, compressing the popliteal artery. Digital subtraction angiography revealed a ruptured saccular aneurysm with a diameter of 7 cm of the popliteal artery. After heparin was administered intravenously, a Fluency™ 6 mm × 40 mm covered stent-graft was inserted. Final angiography showed a well positioned stent-graft excluding the aneurysm without any endoleak. The below-the-knee arteries were all patent. The symptoms of acute limb ischemia gradually disappeared and a surgical evacuation of the hematoma was performed five days after by internal popliteal approach. He was treated with Aspirin, Clopidogrel, Prednisolone and Azathioprine and followed up for 36 months without recurrence of symptoms. Conclusions: Endovascular stent-graft insertion in popliteal artery aneurysms in Behcet's disease might be a safe alternative to surgical intervention. Immunosuppressive therapy should precede the surgical or the endovascular intervention and should be continued after the procedure to avoid postoperative early and late complications.

Keywords

• Popliteal artery
• Aneurysm
• Behçet's disease