Open Repair of a Giant Superficial Femoral-Popliteal Artery Aneurysm Using Autologous Saphenous Vein Bypass: A Case Report.

Peripheral arterial aneurysms are rare but clinically significant because of their risk of thromboembolism and limb-threatening ischemia. Popliteal artery aneurysms are the most common peripheral aneurysms, whereas superficial femoral artery aneurysms are uncommon and often diagnosed late. We report the case of a 60-year-old man who presented with a two-week history of intermittent left thigh pain associated with coldness and numbness. Examination revealed absent distal pulses. CT angiography (CTA) demonstrated a giant superficial femoral-popliteal fusiform aneurysm measuring 7.1 × 5.8 cm and 10 cm in length, with mural thrombosis and preserved distal runoff. The patient underwent aneurysm exclusion and bypass from the mid superficial femoral artery to the distal popliteal artery using a non-reversed in situ autologous great saphenous vein (GSV) graft. Recovery was uneventful, and six-month follow-up confirmed a patent graft with persistent thrombosis of the excluded aneurysm. Early recognition and CTA are essential for diagnosis and operative planning. Open repair with an autologous GSV remains a durable treatment option with excellent long-term outcomes in appropriately selected patients. This case highlights the importance of early diagnosis and timely surgical intervention in achieving successful limb salvage and durable revascularization.