Cosic Luka, Theivendren Mayo, Spanger Manfred, Weinberg Laurence
Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
Department of Vascular Surgery, Austin Hospital, Victoria, 3084, Australia.
Int J Surg Case Rep. 2019;63:1-4. doi: 10.1016/j.ijscr.2019.08.028. Epub 2019 Aug 31.
Popliteal artery aneurysms are a rare occurrence in the general population. We present the case of a male who developed a popliteal artery pseudoaneurysm following chemotherapy for metastatic colorectal cancer.
A 49-year old male presented with a popliteal artery pseudoaneurysm after completing four two-weekly cycles of FOLFOX chemotherapy. There was no history of infection, knee trauma, inflammatory diseases, or any family history of cardiovascular disease or aneurysms. Examination revealed a tender pulsatile mass in the right popliteal fossa with calf oedema. Computed tomography angiography demonstrated a right popliteal pseudoaneurysm, that was treated with endovascular stent grafting.
Anecdotal evidence suggests a link between chemotherapy and the rapid development of abdominal aortic aneurysms exists. Aneurysms have been reported following cisplatin and 5-fluorouracil treatment and trans-arterial administration of irinotecan, a key component of chemotherapy. Chemotherapeutic agents have also been shown to compromise the integrity of the vascular wall through apoptosis of endothelial and smooth muscle cells. In our case, the pseudoaneurysm developed acutely after treatment with FOLFOX, therefore a mechanistic association is plausible.
Differentiating aneurysms as false (pseudo) or true is important to help determine the underlying aetiology. Common causes of pseudoaneurysms include arterial blunt or penetrating trauma. True aneurysms commonly develop from inflammatory atherosclerosis, however mycotic infection, inflammatory arteritis, and entrapment syndrome should be excluded. There may be some evidence to suggest a genetic predisposition to popliteal artery aneurysms. Anecdotal evidence suggests a weak association between chemotherapy and aneurysm progression, warranting further investigation into a causative link.
腘动脉瘤在普通人群中较为罕见。我们报告一例男性患者，其在接受转移性结直肠癌化疗后发生了腘动脉假性动脉瘤。
一名49岁男性在完成四个周期的每两周一次的FOLFOX化疗后，出现了腘动脉假性动脉瘤。患者无感染、膝关节外伤、炎症性疾病史，也无心血管疾病或动脉瘤家族史。检查发现右腘窝有一压痛性搏动性肿块，伴有小腿水肿。计算机断层血管造影显示右腘窝假性动脉瘤，采用血管内支架植入术进行治疗。
有轶事证据表明化疗与腹主动脉瘤的快速发展之间存在联系。顺铂和5-氟尿嘧啶治疗以及化疗的关键成分伊立替康经动脉给药后均有动脉瘤的报道。化疗药物还被证明可通过内皮细胞和平滑肌细胞的凋亡损害血管壁的完整性。在我们的病例中，假性动脉瘤在FOLFOX治疗后急性发生，因此存在机制上的关联是合理的。
区分动脉瘤是假性还是真性对于确定潜在病因很重要。假性动脉瘤的常见原因包括动脉钝性或穿透性创伤。真性动脉瘤通常由炎症性动脉粥样硬化发展而来，不过应排除霉菌性感染、炎症性动脉炎和卡压综合征。可能有一些证据表明腘动脉瘤存在遗传易感性。轶事证据表明化疗与动脉瘤进展之间存在弱关联，有必要进一步研究因果关系。
