Open treatment of an isolated true aneurysm of the anterior tibial artery using the endo-aneurysmorrhaphy technique

Isolated, true atherosclerotic aneurysms of the anterior tibial artery (AT) are rare. Open treatment is indicated for large, asymptomatic lesions or when these aneurysms present with pain due to compression, rupture with resulting compartment syndrome, distal emboli with limb-threatening ischemia, and when the remaining crural vessels have significant disease making revascularization of the AT imperative. We present the case of a 78-year-old man who presented with an isolated, painful atherosclerotic aneurysm of the AT treated by minimal dissection, and an endo-aneurysmorrhaphy technique using saphenous vein interposition grafting. To our knowledge, the use of this technique for the open treatment of a true aneurysm of the AT has not been previously reported.