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16 January 2023 : Case report  Italy

[In Press] A 54-Year-Old Man Who Developed a Femoral Pathologic Fracture from a Giant Popliteal Artery Pseudoaneurysm 7 Years After Ligation and Bypass of a Popliteal Artery Aneurysm: A Case Report and Literature Review

Unusual clinical course, Challenging differential diagnosis

Nicola Monteloene1ABDEF, Francesco Muratori1DF, Alberto Melani2EF, Alberto Schiavo1BEF, Alessandro Alessi Innocenti2F, Domenico Andrea Campanacci ORCID logo1ABDEFG

DOI: 10.12659/AJCR.937113

Am J Case Rep In Press; DOI: 10.12659/AJCR.937113  

Available online: 2023-01-16, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


This case report describes a giant pseudoaneurysm that grew in size during the years following surgical treatment of a popliteal artery aneurysm, eventually causing a femoral fracture. Bone fractures secondary to vascular injuries are rarely described in the literature.
A 54-year-old man underwent surgical ligation and bypass for left popliteal artery aneurysm. Seven years later, he suffered a left distal femur pathologic fracture surrounded by a giant soft-tissue mass. The patient came to us with a diagnostic hypothesis of angiosarcoma from another hospital at imaging evaluation. After computed tomography angiography (CTA) and angio-magnetic resonance imaging (MRI), we made a diagnosis of femoral pathologic fracture caused by a giant pseudoaneurysm of a treated popliteal artery aneurysm refilled by an aberrant anterior tibial artery (IIA2, Kim classification). We performed excision of the mass and open reduction and internal fixation, with anatomic plate, of the fracture. Fracture healing and good functional outcome were observed at follow-up.
A possible complication of surgical treatment of popliteal artery aneurysms is refilling of the excluded aneurysm due to collateral blood flow or, such as in the present case, aberrant vessels. Therefore, the knowledge of anatomical variants of the vessels is important in surgery. Follow-up evaluation after surgery is advisable and a growing mass should be further investigated with an angio-CT scan. In case of a non-pulsating soft-tissue mass causing pathologic bone fracture, a biopsy is mandatory to exclude malignancy.

Keywords: Anatomic Variation; Aneurysm, False; Femoral Fractures

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923