Cutaneous fistula after open repair of a popliteal artery aneurysm: case report and review of the literature

Abstract

Background

For many years, the reference treatment for popliteal artery aneurysms (PA) consists of surgical exclusion by proximal and distal ligation, combined with popliteopopliteal, femoropopliteal or femorotibial bypass. These aneurysms excluded, but left in situ, generally decrease in size by thrombosis. However, this is not always the case. We report on a patient with bilateral PAs. The right aneurysm was completely resected, with a normal follow-up. The left one was excluded by ligation and bypass, without resection, but continued to be perfused, and fistulised to the skin. The aneurysm continued to grow due to retrograde collateral circulation through the knee’s articular arteries, corresponding to a "type 2 endoleak." We therefore performed resection of the aneurysm and its fistulous path. The evolution was favourable and the patient has a satisfactory arterial condition since then. This extremely rare case prompted us to review PAs’ treatment options and explore the arterial aneurysms’ fistulising potential.

Methods

A review of the literature was performed on the aneurysmal fistulas’ clinical manifestation, their pathophysiology, and the PAs’ surgical and endovascular treatment.

Results

Various studies demonstrated a superiority of resection treatments, with better results and fewer reinterventions than exclusion treatments alone.

Conclusions

In view of this case, and as demonstrated by a literature search, we consider the surgical resection of PAs to be the optimal method for their management, rather than the surgical or endovascular exclusion treatment alone.

Keywords:

• Popliteal artery aneurysm
• cutaneous fistula
• aneurysms’ pathophysiology
• endovascular treatment
• open repair

Acknowledgments

I would like to thank Dr. Brion and Dr. Rezai for helping me finalize the project.

Disclosure statement

This declaration states that:

• The authors report no conflicts of interest.

• The present manuscript is original, is not under consideration by another journal and has not been previously published.

• All authors have read and approved the manuscript, and take public responsibility for it.

        

Data availability statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.