Ruptured popliteal artery aneurysm presenting with cardiac arrest and requiring lifesaving amputation: a case report

Abstract

Rupture of a popliteal artery aneurysm (PAA) is a rare but potentially fatal event, often presenting with haemorrhagic shock, limb loss and high mortality. Early diagnosis and prompt surgical management are critical for survival. A 50-year-old previously healthy man was found collapsed, agitated, and complaining of right leg pain. During prehospital transport, he became progressively unresponsive. On arrival at the emergency department, he experienced cardiac arrest with pulseless electrical activity. Advanced cardiovascular life support was initiated, achieving return of spontaneous circulation after three cycles of cardiopulmonary resuscitation. Despite aggressive resuscitation, persistent haemodynamic instability required vasopressor support and massive transfusion. Physical examination revealed a tense haematoma extending from the right thigh to the leg, with absent distal pulses. CT angiography demonstrated active haemorrhage from the right popliteal artery with a large intramuscular haematoma, consistent with ruptured PAA. As vascular surgery was unavailable locally, teleconsultation with a regional centre recommended emergency transfemoral amputation for life-saving haemorrhage control. The amputation was performed without complications. After 14 days in intensive care for pulmonary infection, the patient recovered and was discharged on postoperative day 18. Follow-up showed complete stump healing and successful prosthetic rehabilitation. Ruptured PAA is an extremely rare yet life-threatening condition. In hospitals without vascular surgery, rapid recognition and decisive intervention, including emergency amputation, may be the only viable life-saving option.