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For many years, the reference treatment for popliteal artery aneurysms (PA) consists of surgical exclusion by proximal and distal ligation, combined with popliteopopliteal, femoropopliteal or femorotibial bypass. These aneurysms excluded, but left  in situ , generally decrease in size by thrombosis. However, this is not always the case. We report on a patient with bilateral PAs. The right aneurysm was completely resected, with a normal follow-up. The left one was excluded by ligation and bypass, without resection, but continued to be perfused, and fistulised to the skin. The aneurysm continued to grow due to retrograde collateral circulation through the knee’s articular arteries, corresponding to a "type 2 endoleak." We therefore performed resection of the aneurysm and its fistulous path. The evolution was favourable and the patient has a satisfactory arterial condition since then. This extremely rare case prompted us to review PAs’ treatment options and explore the arterial aneurysms’ fistulising potential. A review of the literature was performed on the aneurysmal fistulas’ clinical manifestation, their pathophysiology, and the PAs’ surgical and endovascular treatment. Various studies demonstrated a superiority of resection treatments, with better results and fewer reinterventions than exclusion treatments alone. In view of this case, and as demonstrated by a literature search, we consider the surgical resection of PAs to be the optimal method for their management, rather than the surgical or endovascular exclusion treatment alone.

Cutaneous fistula after open repair of a popliteal artery aneurysm: case report and review of the literature