Acute arterial occlusion due to thrombotic occlusion of the great saphenous vein graft following popliteal artery aneurysm surgery: a case report

• Aneurysmal degeneration of great saphenous vein grafts has been reported, but is rare. • Enlarged graft aneurysms may rupture or cause peripheral embolism due to thrombus formation. • Surveillance with duplex ultrasonography and prompt surgical intervention are essential. Popliteal artery aneurysms require treatment in symptomatic cases or when the aneurysm diameter exceeds 20 mm, with graft replacement using the great saphenous vein being one of the most common treatment options. Although aneurysmal degeneration of great saphenous vein grafts has been reported, it is rare. We report the case of a 77-year-old woman who had undergone resection of a popliteal artery aneurysm and graft replacement with the left great saphenous vein three years previously. Two years after surgery, angiography revealed a 9.5-mm graft aneurysm, which was managed conservatively. She presented to our hospital with a 3-day history of intermittent claudication and coldness in her left lower limb. On examination, the left popliteal pulse was absent. Ultrasonography suggested acute arterial occlusion due to thrombosis extending from the origin of the superficial femoral artery through the graft to the anterior tibial artery. Emergency surgery was performed, revealing a 35-mm graft aneurysm. Thrombectomy was carried out, followed by aneurysm resection and graft replacement using a newly harvested great saphenous vein. This case highlights that although rare, saphenous vein graft aneurysms can lead to acute arterial occlusion, and early resection and replacement should be considered once detected.