Abstract
Popliteal artery aneurysms are the common peripheral artery aneurysm. Aneurysm due to exostosis is rare in occurrence. Here, we present a rare presentation of popliteal artery aneurysm in siblings which was managed by aneurysm excision and revascularization with interposition reversed long saphenous vein graft in one child and follow-up in the other.
Keywords: Angiogram, bypass, exostosis, popliteal artery aneurysm
Introduction
Peripheral Artery Aneurysms are rare. Aneurysms due to exostosis are uncommon-popliteal Artery Aneurysms due to exostosis in siblings is a likely possibility. Hence the management continues with evaluating the sibling for popliteal Aneurysms.
Case Report
An 18-year-old boy presented with a popliteal aneurysm [Figure 1] measuring 18 cm × 15 cm. He was evaluated with X-ray knee joint [Figure 2] and computed tomography angiogram [Figure 3] which showed the popliteal aneurysm with multiple exostosis.[1,2,3] He was managed by excision[4] [Figure 4] of the aneurysm along with popliteal artery revascularization[2] using reverse long saphenous vein as interposition graft.
Figure 1.
Popliteal aneurysm
Figure 2.
Exostosis causing aneurysm
Figure 3.
Angiogram showing popliteal aneurysm
Figure 4.
Aneurysm excision
The patient's brother aged 13 years was also found to have multiple exostosis [Figure 5], one at the posteromedial aspect without any symptoms in the right leg. He was evaluated with a duplex scan which showed dilated popliteal artery without aneurysmal changes. Hence, it was concluded that future aneurysm was likely because of the position of exostosis [Figure 6] near the popliteal artery.
Figure 5.
Aneurysm due to exostosis in siblings
Figure 6.
Exostosis in sibling
The likely possibility of aneurysm was discussed with the parents and hence was advised for yearly follow-up.
Discussion
Hereditary multiple exostoses is an autosomal dominant skeletal disorder characterized by the formation of cartilage-capped prominences developing from the juxta-epiphyseal regions of long bones and causing orthopedic deformities and occasionally sarcomatous degeneration. Osteochondromas most commonly arise from the lower end of femur, the upper end of tibia and fibula and the upper end of humerus. Ninety percent of exostosis is solitary.
Exostosis is benign tumors, but may lead to serious complications such as fracture through tumor pedicle, restriction of joint movements, nerve and vessel compression,[1,2] and sarcomatous change.
Vascular complication includes the development of a false aneurysm, arterial compression,[5] arteriovenous fistula, occlusion, arterial rupture, arterial thrombosis,[6] and luminal stenosis due to extrinsic compression. Venous complications are even rarer and include deep venous thrombosis and compression.
The formation of a false aneurysm[1,2] is due to the repetitive trauma to the arterial wall by a spike of the osteochondroma during flexion and extension of the knee. This repeated trauma chronically abrade the popliteal artery and produce an adventitial defect followed by a pseudo-aneurysm.[3,5]
The treatment of popliteal false aneurysm is surgical removal of the exostosis[4] and restoration of the vascular axis. Some authors suggest preventive removal of exostoses situated on a vascular axis to hinder the onset of such accidents while others suggest that surgical removal is indicated in case of malignant change, or when the vascular axis is compromised.[6]
The likely possibility of aneurysm was discussed with the parents. The option of either removal of exostosis or regular follow-up was explained. The parents agreed to bring the child for follow-up.
Conclusion
This case is presented for the need for examination and diagnostic workup in siblings with popliteal aneurysm due to exostosis.[1] The role of primary care physician is important in evaluating the siblings in case of exostosis with popliteal aneurysm and most importantly in following these patients with clinical examination and timely referral to a specialized vascular center for further management of the aneurysm before any complications.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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