A unique case of thrombosed giant popliteal aneurysm.

We report a unique case of a giant, thrombosed, and ruptured popliteal aneurysm measuring 13.8 cm x 14.0 cm x 14.0 cm in a 93-year-old man. The patient is a hypertensive smoker with asymptomatic swelling behind the knee for several years who developed pain in the swelling with ecchymosis for 2 weeks before presentation. Despite rupture of the aneurysm, this patient exhibited no ischemic symptoms. The patient underwent emergency surgery in which most of the aneurysmal sac was excised and because of satisfactory collateral circulation, the proximal and distal popliteal artery was suture-ligated. Remarkably, the patient did not require a bypass graft and at follow up is pain-free and ambulating with no clinical signs or symptoms of ischemia. This case is unique in several ways: (1) to our knowledge, this is the largest popliteal aneurysm compared with any case that has been documented in the literature, (2) this is also the oldest reported age ever associated with a popliteal aneurysm, and (3) exclusion suture ligation proximally and distally has resulted in an exceptional outcome.