Background
Expansion after popliteal artery aneurysm exclusion with bypass is a common phenomenon.
Popliteal angiosarcoma is seldom reported in literature and in most cases after popliteal
artery aneurysm surgery. This paper aims to present the case of a popliteal angiosarcoma,
initially diagnosed as late aneurysmal growth after exclusion surgery, to conduct
a systematic review of popliteal angiosarcoma and assess any association between angiosarcoma
and previous popliteal aneurysm surgery.
Methods
We performed a secondary popliteal aneurysmorraphy through posterior approach for
symptomatic aneurysm expansion in a 79-year-old woman, 9 years after medial femoropopliteal
venous bypass and aneurysm exclusion. The postoperative course was complicated by
recurrent hematomas and wound spillages requiring multiple revisions. Pathological
analysis identified an angiosarcoma. Staging revealed bone invasion and pulmonary
metastasis. Despite transfemoral amputation and adjuvant chemotherapy the patient
died 8 months later.
We performed a systematic review through MEDLINE on ‘primary’ and ‘secondary’ (with
previous vascular surgery) angiosarcoma in popliteal artery aneurysm. Research was
done using the terms ‘(hem) angiosarcoma’, ‘aneurysm’, ‘popliteal aneurysm or artery’,
‘femoral aneurysm or artery’. Other soft tissue sarcoma or nonpopliteal locations
were excluded.
Results
Including this case, only 13 angiosarcomas in popliteal aneurysms are currently described.
Two were reported without previous surgery considered as primary angiosarcoma and
11 after popliteal artery aneurysm surgery (secondary angiosarcoma). Patient age ranges
from 8 months to 83 years with a male predominance (10/3). Nine of the 11 patients
with secondary angiosarcoma were initially diagnosed as popliteal aneurysm expansion
after previous bypass surgery, the 2 other secondary cases presented respectively
with pain and inflammatory syndrome without expansion. All prior surgical exclusion
was carried out by a medial approach. Interval with the index operation ranges from
3 months to 15 years. Death was reported in 8 of the 13 cases within the first year
of diagnosis.
Conclusions
Although seldom reported, popliteal angiosarcomas are mainly described after popliteal
artery aneurysm exclusion surgery, raising suspicion on a potential association, yet
causality cannot be demonstrated. Angiosarcoma should be included in the differential
diagnosis of popliteal aneurysm growth or unexpected outcome after exclusion bypass
surgery. Systematic imaging and pathological studies should be undertaken to allow
early diagnosis and treatment. Routine use of a posterior approach, with aneurysm
resection, when feasible as initial popliteal artery aneurysm treatment, might reduce
the risk of late sarcomatous transformation.
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Article Info
Publication History
Published online: July 08, 2022
Accepted:
June 2,
2022
Received in revised form:
May 30,
2022
Received:
March 8,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of Interest: None.
Funding: None.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
