Abstract
A ruptured popliteal artery aneurysm (PPA) is a life-threatening condition that can mimic deep vein thrombosis and lead to critical limb ischemia. Immediate and accurate diagnosis is essential to save the patient's life and limb. A 73-year-old male presented with acute pain in the posterior aspect of the right knee. Contrast-enhanced computed tomography revealed a ruptured PPA measuring 65 mm with a distal embolism. Emergency surgery was performed, successfully removing the aneurysm and embolus, followed by reconstruction using the saphenous vein. The patient was discharged 12 days postoperatively. This case involved both rupture and embolization, causing hemorrhagic shock and severe leg ischemia. Although endovascular treatment offers outcomes comparable to open surgery in intermediate follow-ups, it may not adequately address severe ischemia in such cases. Open surgical repair with a saphenous vein graft, combined with endovascular techniques, allowed effective bleeding control and restoration of blood flow. This case underscores the importance of rapid diagnosis and tailored treatment strategies to achieve optimal outcomes.