Popliteal artery aneurysm in behcet’s disease: a case-based review

Behçet’s disease (BD) affects both arteries and veins, presenting as a vasculitic condition. Aneurysms of the aorta and pulmonary arteries are the most common type of arterial involvement. Popliteal artery aneurysm (Pop-AA) is rarely seen. It can be overlooked due to its appearance behind the knee and its rarity. Early detection and appropriate management are crucial to prevent serious outcomes. In this case-based review, we aim to discuss the course and outcome of popliteal artery aneurysms by reviewing similar cases published in the literature and reporting our own case. We searched the the literature in databases of PubMed, Web of Science, and Google Scholar with the MeSH keywords “Behcet’s disease” or “Behcet’s syndrome”, and “popliteal artery aneurysm”. The International Study Group Classification Criteria are used to diagnose BD. Of the 143 publications, 20 were considered for evaluation. 23 cases, together with our own case, were eligible for evaluation (24 cases). All the patients were male. The mean onset age of BD was 37.8 ± 12.4 years. In one case, Pop-AA developed before the diagnosis of BD. Pop-AA developed 90.2 ± 102 months after the diagnosis of BD. The mean age of BD patients when Pop-AA developed was 44.9 ± 12.3 years. Pop-AAs are seen with other artery aneurysms developing at the same time or at different times, and/or with venous involvement. Femoral artery aneurysm and aortic aneurysm were observed in 8 and 3 cases, respectively. As for venous vessel involvement, 10 (41.6%) of the subjects had deep venous thrombosis, 2 patients had superior vena cava syndrome (8%), and 4 patients had superficial thrombophlebitis (17%). In most cases, it has not been observed that preoperative and postoperative immunosuppressants are applied. Two patients underwent extremity amputation. Two cases died of pulmonary embolism and infection, respectively. Our case was treated with stent graft. However, 5 months later, stent graft occluded and required blood flow was restored with angioplasty. Pop-AA can occur in BD patients who have experienced a long duration of the disease. Patients with BD who have knee pain should also be evaluated for Pop-AA.