• Kai Liu, Lin Mu, Shuai Yan, Renshi Ma, and Bin Liu.
• Department of Hand and Foot Surgery.
• Medicine (Baltimore). 2020 Jul 31; 99 (31): e21523.

RationaleAn extremely rare spontaneous pseudoaneurysm (PSA) of the posterior tibial artery (PTA) in a middle-aged male patient was cured by open surgery effectively.Patient ConcernsA 53-year-old man presented with the increasing swollen left shank for 1 day, with intermittent pain, pulselessness and pallor. He denied the history of trauma, infection, and other diseases.DiagnosesPhysical examination, past medical history, ankle brachial index, ultrasonography, computed tomographic angiography (CTA), 3-dimensional reconstruction image of the popliteal artery and its branches and histological examination of intraluminal thrombus and clots helped us diagnose the patient as spontaneous PSA of PTA.InterventionsOur patient underwent excision of PSA and repair operation of PSA.OutcomesThe patient recovered well at 2-year follow-up.LessonsThis rare case provides valuable insights for tissue repair and vascular surgery. Therapeutic methods should be in accordance with the best interest of patient. Open surgery is the effective treatment for spontaneous PSA of PTA.

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