Aneurysm involving distal fibular artery in a patient with B
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A 42-year-old woman presented with a pulsatile mass in her right anterior lateral ankle region. She had a 6-year history of Behçet's disease with pyrexia of unknown origin, recurrent oral, and genital ulcers, anterior uveitis, and hemoptysis, and she had been treated with prednisolone and cyclophosphamide.

Computerized tomography showed that the aneurysm measuring a maximum of 2 cm originated from the distal part of the fibular artery in the right leg. Macroscopy revealed an aneurysm with a white and smooth round surface. Histological sections of the resected aneurysm revealed a severely hyperplastic intima layer with fibromyxoma-like tissues and proliferating fibroblasts. In the media and adventitia, there were increased numbers of capillaries, small arteries, and veins with infiltration of mononuclear cells, including lymphocytes and plasma cells, around the proliferated vasa vasorum.

Behçet's disease is an inflammatory disorder that affects multiple organs. Although vessels are target organs in Behçet's disease, a tibial, fibula, or dorsalis pedis artery aneurysm in Behçet's disease is rare. An aneurysm of such sites can be caused by blunt trauma of the foot. Doctors confirmed from the pathological findings that the aneurysm was a true aneurysm, not a traumatic pseudoaneurysm, due to Behçet's disease. It is well known that the risk of rupture of an aneurysm in extremity arteries is relatively low. Thus, surgical repair of below the knee aneurysms is often performed on standby. Since the size of the aneurysm, in this case, was more than two times larger than the natural artery size, they selected surgical repair.

Source: https://academic.oup.com/ehjcr/advance-article/doi/10.1093/ehjcr/ytaa282/5908070?rss=1
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