Bilateral Popliteal Artery Aneurysms with Rupture and Pseudoaneurysm Formation on the Left

The rupture of a popliteal artery aneurysm is very rare, and can lead to serious complications if untreated. Any reports of a huge pseudoaneurysm, following rupture of the popliteal artery aneurysm could not be found in a review of the literature. A pulsatile huge mass leading to a deep venous thrombosis, was observed in a 74 years old male patient who for 2 months had had a progressively swollen and painful left leg. On angiographic evaluation, the mass was found to be a pseudoaneurysm originating from a ruptured true aneurysm of the popliteal artery. There was also a small true aneurysm in the contralateral extremity at the same localization. Both the false, and true aneurysms were resected surgically and arterial continuity was established with a synthetic polytetrafluoroethylene graft.

Surgical Treatment of Bilateral Intracranial Aneurysms

The incidence of the bilateral intracranial aneurysms in multiple aneurysms ranges from 20 to 40% in the published series12). The problems of surgery for multiple aneurysms are far greater than those for single aneurysm. Occasionally,the ruptured site of bilateral symmetrical(mirror image) aneurysms are more difficult to identify. To verify the standard treament, we investigated their clinical data and surgical modalities of 43 patients with bilateral aneurysms. We classified the bilateral aneurysms as symmetrical and asymmetrical aneurysms. Most common bilateral symmetrical aneurysms were located at origin of posterior communicating artery. Surgical modalities were separate craniotomy with ipsilateral approach(29 cases) and a single craniotomy with ipsilateral and contralateral approach (6 cases). The rest of patients were treated only in the presence of symatomatic lesions. Seven patients died of various causes; two were rebleeding, three were surgical mortalities, and two had medical complications. The surgical results were good to fair in 26 cases of separate operation and had good to fair outcome of 5 cases with 1 case of poor outcome in the single craniotomy with combined ipsilateral and contralateral approach. Surgical goal in patient with bilateral aneruysms is clipping of all aneurysms. In selected cases, the contralateral approach with a single craniotomy can be employed. Proper surgical techniques and guideline for microsurgical exposure of bilateral aneurysms are mandatory.

Unilateral Approach to Bilateral Aneurysms: Case Report

Patients with bilateral multiple intracranial aneurysms present a great challenge for determining whether surgical method should e one-stage or two-stage operation. The possibility of fatal rupture of unclipped aneurysm during hemodynamic change of perioperative period after clipping of ruptured aneurysm warrant the one stage operation when contralateral aneurysm is accessible. We clipped the M1 aneurysm of middle cerebral artery and contralateral posterior communicating aneurysm at the same the successfully via the pterional approach.