Endovascular stenting of popliteal artery pseudoaneurysms: Will this alternative be the new standard? A case report

Traumatic popliteal artery pseudoaneurysms post-total knee replacement are uncommon and those of bilobed morphology are even more rare. We present a case of a patient with a bilobed traumatic popliteal artery pseudoaneurysm after knee replacement surgery, treated with popliteal artery stenting. A 75-year-old patient presented 12 days post left total knee replacement with left leg pain and swelling. A duplex ultrasound scan performed demonstrated a popliteal vein occlusive thrombus and a 2.6cm aneurysm of the left popliteal artery. Due to worsening pain and leg swelling, a CT angiogram scan was performed which demonstrated a large bilobed pseudoaneurysm of the popliteal artery. This necessitated emergent treatment and percutaneous popliteal artery stenting was performed. Initial angiography demonstrated extravasation of contrast into a pseudo aneurysm sac, and this was treated with a 6mm x 100mm self-expanding covered stent-graft (Gore Viabahn TM ). The patient recuperated well. This case describes a patient with delayed presentation of a bilobed arterial pseudoaneurysm due to iatrogenic trauma. The presence of deep venous thrombosis in this case clouded and delayed the diagnosis of popliteal artery pseudoaneurysm. Bilobed popliteal artery pseudoaneurysms are rare with an unknown incidence while popliteal artery pseudoaneurysms are a recognized but uncommon complication during total knee arthroplasty, with an incidence between 0.03%-0.51%. Popliteal artery pseudoaneurysm stenting has favorable short and mid-term results but given its rarity, high quality studies with comparison of various techniques are difficult to perform, resulting in paucity of data on long-term outcomes. Therefore, life-long stent surveillance is advocated.