Ruptured pseudo-aneurysm of the popliteal artery after percutaneous transluminal angioplasty

An 88-year-old female presented with gangrene of two toes of the left foot. Angiography revealed a calcified occlusion of the left popliteal artery, 8 cm in length. Recanalisation was performed and the occlusion was successfully dilated. On day 13 after the procedure, the patient experienced acute pain in the left popliteal fossa. Ultrasound revealed a large pseudo-aneurysm of the popliteal artery. Angiography not only confirmed this finding but showed rupture of this pseudo-aneurysm. An above-knee amputation was performed. Pseudo-aneurysm formation at the site of previous PTA is considered as a rare complication and has not been reported in the literature. The incidence of pseudo-aneurysm formation at a PTA site is unknown because it is not routinely detected. Predisposing general and local factors are discussed. The present case illustrates that pseudo-aneurysms can cause other major complications with disastrous consequences for the patient. Pseudo-aneurysms after previous PTA should be treated by conventional bypass surgery or by endovascular means. Further studies should be undertaken to evaluate the risk of pseudo-aneurysm formation after previous PTA and to define which patients should be monitored closely.