title: Hybrid treatment of a symptomatic popliteal pseudoaneurysm due to type-I endoleak after previous endovascular exclusion.
abstract: OBJECTIVE
  The development of endovascular repair of popliteal aneurysms has provided an alternative, minimally invasive way of treatment. We present a case of a late type-I endoleak, after previous exclusion of a popliteal pseudoaneurysm, leading to rupture and massive hematoma, which was excluded in a hybrid procedure.
  
  
  METHODS
  A 95-year-old woman presented with progressive swelling with skin ulceration and necrosis cranial to the medial side of her left knee. Four years earlier, a left popliteal pseudoaneurysm was excluded with a stent-graft. Rupture of the popliteal artery with massive hematoma was demonstrated by ultrasound examination and a spiral computed tomography scan, with high suspicion of a type-I endoleak. Endovascular repair of the endoleak with a polytetrafluoroethylene-covered stent-graft was followed by surgical resection of the damaged skin and evacuation of the hematoma.
  
  
  CONCLUSIONS
  Type-I endoleaks after endovascular exclusion of popliteal pseudoaneurysms do occur and may lead to rupture. A symptomatic pseudoaneurysm may be successfully treated by a hybrid procedure.
authors.affiliation: Department of Surgery (Division of Vascular Surgery), Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands.
authors.forename: Heleen D
authors.initials: HD
authors.lastname: de Koning
authors.forename: Clark J
authors.initials: CJ
authors.lastname: Zeebregts
authors.forename: Michel M P J
authors.initials: MM
authors.lastname: Reijnen
mesh_terms: D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000473:pathology / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000473:pathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009336:Necrosis; D011150:Popliteal Artery / Q000473:pathology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D036542:Tomography, Spiral Computed