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Popliteal artery aneurysmal dilatation by intimomedial mucoid degeneration causing emergency limb ischemia: a case report and literature review

  • Kaisor Iqbal1,†
  • Mohammed Yousef Aldossary1,2,*,†,
  • Sultan AlSheikh1
  • Mohammed Alsawyyed3
  • Mogren Almogren1,4
  • Abdulmajeed Altoijry1

1Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, 11322 Riyadh, Saudi Arabia

2Division of Vascular Surgery, Department of Surgery, Dammam Medical Complex, 32245 Dammam, Saudi Arabia

3Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, 11322 Riyadh, Saudi Arabia

4Division of Vascular Surgery, Department of Surgery, King Fahad Military Medical Complex, 32227 Dhahran, Saudi Arabia

DOI: 10.22514/sv.2024.010 Vol.20,Issue 1,January 2024 pp.140-144

Submitted: 27 October 2022 Accepted: 01 December 2022

Published: 08 January 2024

*Corresponding Author(s): Mohammed Yousef Aldossary E-mail:

† These authors contributed equally.


Intimomedial mucoid degeneration (IMMD) is an extremely rare vascular condition characterized by mucin accumulation in the intima and media, resulting in arterial wall elastic tissue degradation and aneurysm formation. We report the case of a 34-year-old woman who presented to the emergency department with a 1-month history of left lower limb pain. On local physical examination, both lower limbs were warm with palpable regular pulses in the entire lower limbs and normally capillary refill. No palpable masses were felt. Computed tomography angiography (CTA) of the lower limbs revealed an aneurysm with a thrombosed sac in the left popliteal artery behind the knee joint. Thoracic and abdominal CTA revealed normal findings. The patient underwent posterior exploration of the left popliteal artery, which revealed a large aneurysm requiring excision, and an interposition vein graft end-to-end anastomosis was performed. Histopathological examination of the aneurysm disclosed the presence of fibrosis, scattered chronic inflammatory cells, and a hyalinized fibrin thrombus associated with marked fragmentation and distortion of the elastic tissue. Extensive mucoid deposition in the intima and media of the artery was also detected. The postoperative recovery was uneventful, and the patient was discharged home with regular follow-up during the last year in our outpatient clinic. IMMD can affect smaller vessels such the brachial, coronary, temporal arteries, and dorsalis pedis. The main histological hallmarks of IMMD include intimal and medial thickening caused by the formation of mucin pools, which leads to elastin fibers fragmentation and aggregation. The prognosis of IMMD-related aneurysms is determined by the extent of the disease and the time it is discovered. IMMD-related aneurysms should be included in the differential diagnosis of isolated popliteal artery aneurysms. Open surgical repair is the gold standard of treatment for IMMD-related aneurysms.


Intimomedial mucoid degeneration; Emergency limb ischemia; Arterial disease; Popliteal artery; Aneurysm; Open repair

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Kaisor Iqbal,Mohammed Yousef Aldossary,Sultan AlSheikh,Mohammed Alsawyyed,Mogren Almogren,Abdulmajeed Altoijry. Popliteal artery aneurysmal dilatation by intimomedial mucoid degeneration causing emergency limb ischemia: a case report and literature review. Signa Vitae. 2024. 20(1);140-144.


[1] Decker GA, Samson ID, Schmaman A. Abdominal aneurysm in South African Negroes due to intimomedial mucoid degeneration. British Journal of Surgery. 1977; 64: 513–516.

[2] Katz JR, West DL, Bui JT, Knuttinen G, Chejfec G, Owens CA. Endovascular treatment of intimomedial mucoid degeneration. Journal of Vascular and Interventional Radiology. 2008; 19: 1765–1768.

[3] Sandhyamani S. Mucoid vasculopathy of unknown etiology. Angiology. 1991; 42: 48–51.

[4] Raber MH, Meerwaldt R, Van Det RJ. A young man with intimomedial mucoid degeneration of the brachial artery. Journal of Vascular Surgery. 2011; 53: 822–824.

[5] Jessurun GAJ, Tio RA, Ribbert LSM, Willemse F, Boonstra PW, Crijns HJGM. Unusual cause of sudden cardiac death: basophilic degeneration of coronary arteries. Catheterization and Cardiovascular Diagnosis. 1996; 39: 172–176.

[6] Abdool-Carrim AT, Robbs JV, Kadwa AM, Kenoyer G, Cooper K. Aneurysms due to intimomedial mucoid degeneration. European Journal of Vascular and Endovascular Surgery. 1996; 11: 324–329.

[7] Wali MA, Dewan M, Renno WM, Ezzeddin M. Mucoid degeneration of the brachial artery: case report and a review of literature. Journal of the Royal College of Surgeons of Edinburgh. 1999; 44: 126–129.

[8] Gajjar H, Beningfield SJ, Naidoo NG, Motala A. Multiple aneurysms due to intimomedial mucoid degeneration: a short presentation: pictorial essay. SA Journal of Radiology. 2009; 13: 98–101.

[9] Pepler WJ. A study of some of the structural changes of the bantu aorta. South African Journal of Laboratory and Clinical Medicine. 1955; 1: 203–253.

[10] Steiner I, Thomas JD, Hutt MS. Aortopathies in Ugandan Africans. The Journal of Pathology. 1973; 109: 295–305.

[11] Cooper K. Extraaortic intimomedial mucoid degeneration: a clinicopathological study. Angiology. 1993; 44: 477–482.

[12] Golchehr B, Zeebregts CJ, Reijnen MMPJ, Tielliu IFJ. Long-term outcome of endovascular popliteal artery aneurysm repair. Journal of Vascular Surgery. 2018; 67: 1797–1804.

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