Bilateral Popliteal Artery Aneurysms as a Manifestation of Vascular Behçet Disease: A Case Report and Literature Review

Background and Clinical Significance: Popliteal artery aneurysmal involvement is an uncommon arterial manifestation of Behçet disease, and bilateral disease with thrombotic complications is particularly rare. Management is challenging because urgent limb revascularization must be balanced against an inflammatory vasculopathy associated with recurrent arterial events and loss of graft patency. Case presentation: A 50-year-old man presented with Rutherford IIa acute right lower-limb ischemia caused by thrombosis and distal embolization from a 4.4 cm true fusiform distal femoral-to-popliteal aneurysm. Computed tomography angiography also demonstrated a 2.4 cm contralateral true fusiform aneurysm with mural thrombus. Catheter-directed thrombolysis and adjunctive endovascular treatment restored distal perfusion, followed by Viabahn covered-stent exclusion of the right aneurysm. The asymptomatic left aneurysm was electively excluded 5 months later. Within the following year, acute left stent-graft occlusion required endovascular salvage, while right in-stent restenosis was treated with drug-coated balloon angioplasty. Recurrent vascular events prompted rheumatological evaluation, and vascular Behçet disease was diagnosed in 2022, followed by corticosteroid and methotrexate therapy. During approximately 5 years of follow-up, both popliteal stent grafts eventually occluded; however, collateral perfusion preserved limb viability, with only mild intermittent claudication and no rest pain or tissue loss at the latest follow-up. Conclusions: Bilateral popliteal aneurysmal disease with thrombosis may lead to recognition of vascular Behçet disease. Endovascular exclusion can provide immediate limb salvage and aneurysm control, but recurrent thrombosis, restenosis, and late loss of patency remain possible. Long-term management should integrate inflammatory disease control with vascular surveillance while distinguishing anatomical graft failure from clinical limb outcome.