Twenty-year experience of femoral artery aneurysms

Journal of Vascular Surgery, 2008

Because there is a paucity of data about management and outcome of true profunda femoris artery aneurysms (PFAAs), we reviewed our 21-year experience with surgical repair of PFAAs. Methods: Clinical data from the 15 patients who underwent repair between 1985 and 2006 were retrospectively reviewed. Results: Fifteen men had 17 PFAAs (mean diameter, of 3.4 cm). Three had an acute presentation with rupture (n ‫؍‬ 2) or acute limb ischemia (n ‫؍‬ 1), one had local tenderness, and 11 were asymptomatic. Sizes of the ruptured PFAAs were 1.5 and 7.5 cm. Eleven patients (73%) had synchronous aneurysms, most frequently in the popliteal artery (n ‫؍‬ 7). Three of the asymptomatic patients required an emergency operation because of acute lower extremity ischemia caused by thrombosis of a synchronous popliteal aneurysm (n ‫؍‬ 2) or for a ruptured iliac aneurysm (n ‫؍‬ 1). Aneurysmectomy with graft interposition between the common femoral and PFA was used in 15 repairs. Ligation alone was used for one aneurysm, and another was treated by partial aneurysmectomy with primary repair. There were no deaths, graft thrombosis, or limb loss at 30 days. At a mean follow-up of 28 months (range, 3 to 108 months), one patient required above knee amputation 2 years after aneurysm ligation, and another patient presented with a recurrent aneurysm. Long-term graft patency was 100%. Conclusions: PFAAs are rare but often occur with synchronous aneurysms. One-third of patients presented with complications of limb ischemia or rupture caused by their PFAA or synchronous aneurysms. Good-risk patients with a PFAA >2 cm should undergo elective repair. Aneurysmectomy with femoral interposition graft is a durable repair.

Journal of Experimental & Clinical Medicine, 2019

0 0 1 118 676 OMU Medical Faculty 5 1 793 14.0 96 Normal 0 false false false EN-US JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:Calibri;} Popliteal artery aneurysm are seen more common than femoral artery aneurysms. Common femoral artery (CFA) aneuryms, superficial femoral artery (SFA) aneurysms and profound femoral artery (PFA) aneurysms are relatively rare and incidence rates are 80%, 15% and 5% respectively among the all femoral artery aneurysms and most of them are pseudoaneurysms. True aneurysms are often seen bilaterally (38%) and accompanying popliteal artery aneurysms (%27-44) or abdominal aorta aneurysms (%50-90). These aneuryms can be thrombose, em...

Polish Journal of Surgery, 2009

Percutaneous cardiac interventions are nowadays the most common cause of the femoral artery injury. In these cases, surgical intervention was for many years considered the treatment of choice. Satisfactory results of conservative and minimally invasive treatment has changed the state of art. the aim of the study was the analysis of treatment results in patients with iatrogenic femoral aneurysm. material and methods. In the period of 3 years between 2004 and 2006 in 66 patients an iatrogenic, spure femoral artery aneurysm was recognized. There were 36 women and 30 men in this group. The mean age was 68.8 years. All patients were included prospectively in the study. According to aneurysm morphology, compression pliability and patient choice 45 individuals were assigned to OT group, remaining 21 were treated conservatively: US-guided compression in all patients and thrombin injection if compression failed. results. There was one death in OT group due to underlying coronary disease and in our opinion unrelated to surgical treatment. Other major adverse events were one postoperative stroke in OT group and superficial femoral artery thrombosis in NT group. 8 patients experienced minor events and they all were operative wound complications. No other complications were observed in NT group. Post procedural stay was longer for the OT group (8.7 vs 3.8 days, p<0.05). Length of hospital stay was also significantly correlated with presence of complications (5.5 days for patients without complications and 16.9 days for the complicated cases, p<0.001).The procedure was successful in 95.2% and 100% in the groups of NT and OT respectively. conclusions. Utilized criteria of patients' assignment to conservative and operative treatment allowed plausible treatment results. OT and complications significantly increase the length of hospitalization. It is mandatory to remember of possible thrombotic complications related to thrombin injections.

European Journal of Vascular and Endovascular Surgery, 2008

Purpose. To review the pathogenesis, diagnosis, presentation, diagnosis, management and outcomes (morbidity and mortality) of superficial femoral artery aneurysms. Methods. A comprehensive review of this entity was performed based on the available literature in all languages and a detailed discussion of our findings is also provided. Results. Our review identified 61 cases of SFA aneurysms. They were most often seen in elderly men, predominately affected the right lower extremity, and were most often located in the middle-third of the artery. At the time of diagnosis, SFA aneurysms were frequently symptomatic because they reached a relative large diameter before the diagnosis was made. The most frequent presentation was localized pain in association with a pulsatile mass. In contrast to popliteal aneurysms, SFA aneurysms more frequently present with rupture than distal ischemia. Angiography was by far the most commonly utilized diagnostic tool. Treatment was primarily by means of an interposition graft, followed by exclusion and surgical bypass. Endovascular repair of SFA aneurysms has only been reported in three instances. SFA aneurysm repair was most often associated with favorable outcomes, with low reported rates of ischemia and limb loss. Ó

Cardiovascular Surgery, 1999

In this study, the files of 112 patients with a total of 142 femoral anastomotic aneurysms were reviewed. Eighty-five patients (76%) were initially operated upon for obstructive aortoiliac disease, while the remaining 27 (24%) had abdominal aortic aneurysms repaired. The majority of the patients (104/112) were male and their mean age was 64.5 years (range 45-88). Ninety-three per cent of the subjects were smokers prior to the first operation and 43% continued to smoke at the time of their femoral anastomotic aneurysms operation. The mean delay between the initial surgery and the repair of the femoral anastomotic aneurysms was 74.5 months (range 1-228). The diagnosis was made because of a painless pulsatile mass (91/142), acute leg ischaemia (27/142), a painful pulsatile mass (12/142), haemorrhage (10/142), pseudo-post-phlebitic oedema (1/142) and microemboli of the toes (1/142). The operative mortality was 2.7% (3/112) of which two-thirds were patients with infected grafts. Two subgroups were distinguished: 10 patients with an infected femoral anastomotic aneurysm and 12 patients with recurrent femoral anastomotic aneurysms, 11 with a single recurrence and one with a double recurrence. In the infected group, the time to development of anastomotic aneurysm was shorter than for the group with non-infected femoral anastomotic aneurysms (41 versus 74.5 months) and the operative mortality was 20% (2/10). One patient developed a recurrent femoral anastomotic aneurysm and another was lost to follow-up. Two subsequent deaths occurred, which were unrelated to the femoral anastomotic aneurysms. In the group of recurrent femoral anastomotic aneurysms one patient was lost to follow-up and two patients died, but not as a result of recurrent femoral anastomotic aneurysms. A total of 122 cases underwent interposition of a new prosthetic segment between the proximal prosthesis and the distal artery (89 at the common femoral, 21 at the femoral profundis, eight at the superficial femoral and four at an existing femoro-popliteal graft).

CardioVascular and Interventional Radiology, 2006

Purpose: To assess the effectiveness of endovascular treatment of femoropopliteal aneurysms (FPAs). Methods: In the last 5 years, we have treated 17 FPAs (diameter 21-75 cm, mean 38.4 cm; length 27-100 cm, mean 72.5 cm) in 15 patients (age 57-80 years, mean 70.9 years). The diagnosis was obtained by color Doppler ultrasound (CDU) and the procedure was planned by CT angiography (CTA) and preprocedural angiography. Eight FPAs were excluded with only one stent-graft; in 8 patients, two stent-grafts were positioned; and in 1 patient, three stentgrafts were used. In 14 cases we used a Wallgraft endoprosthesis, in 2 cases a Hemobahn, and in 1 case an Excluder contralateral leg. The patients were followed up with CDU and occasionally with CTA. Results: Immediate technical success was obtained in 17 of 17 cases (100%). One patient died during the first year. During a mean follow-up of 26.9 months (range 3-60 months) we observed 6 of 16 (38%) stent-graft occlusions (3 of which were recanalized with locoregional thrombolysis and 3 with mechanical thrombectomy). Two stent-grafts were patent at 12 and 24 months. Four patients experienced subsequent occlusions and recanalizations until corrected by surgical bypass (1 at 14 months, 2 at 18 months, and 1 at 36 months). Therefore the primary patency was 63% and assisted patency was 73%. Conclusion: The endovascular approach is a minimally invasive treatment option for FPAs. Moreover endovascular stent-grafting does not necessarily preclude conventional surgical repair, but it can delay it. Longer follow-up will be needed to determine the long-term patency rate.

Annales de Chirurgie Vasculaire, 2010

Pseudoaneurysms of the profunda femoral artery (PFA) have been reported following different types of trauma, mostly iatrogenic. We present three cases of PFA false aneurysm formation, two after vascular procedures and one as a result of a gunshot injury, which were successfully treated with the endovascular deployment of covered stents. Treating these patients by endoluminal means is an efficient and feasible minimally invasive approach. If the patient is relatively stable and there are no major compression issues, stenting could be considered as adequate therapy for these situations. Certainly, a larger series are needed in order to testify to the long-term results and ascertain the durability of such a repair.

European Journal of Vascular and Endovascular Surgery, 2000

Introduction Ultrasound evaluation and angiography revealed a 6 cm SFAA. In the theatre a ruptured aneurysm of the Superficial femoral artery aneurysms (SFAAs) are distal superficial femoral artery (SFA) was confirmed. Total resection of the SFAA was performed and a 10-rare. 1 Atherosclerotic SFAAs usually remain undetected until rupture takes place, 2 in contrast with cm-long 6-mm polytetrafluoroethylene (PTFE) graft was interposed. Ligation of the popliteal vein was also aneurysms of the common femoral and popliteal artery whose rupture is distinctly uncommon. 3-5 Infected necessary. He was discharged 5 days later in good condition. SFAAs have a high tendency to rupture. The physician must be aware of their development in patients with bacteraemia, keeping in mind that their clinical presentation may sometimes be obscure. 6 During the period 1990 to February 1999, 153 Case 2 patients were operated on for aneurysmal disease in our institution, including two patients with SFAA, A 66-year-old male was admitted with a suspected giving an incidence of 1.5%. The first patient presented deep venous thrombosis. Thirty days before admission with rupture of an atherosclerotic aneurysm and the he had a urinary tract infection, due to Escherichia coli. second one with simultaneous rupture of bilateral Twenty days later he developed pain and swelling in SFAAs. We report our experience in the management both lower limbs with persistent fever, despite the of SFAAs and the use of prosthetic grafts in infected antibiotic therapy. aneurysms, where the traditional practice demands On physical examination, the patient was pale and avoidance of such a material. A review of the literature had a low-grade fever. Tender, erythematous, pulsatile regarding SFAAs is also presented. masses were detected on the anteromedial aspect of both lower thighs. The calves were normal, distal pulses were present and the rest of the physical ex-Case 1 amination was unremarkable. Ultrasound evaluation revealed bilateral SFAAs with a small area of peri-An 81-year-old male with a known abdominal aortic aneurysmal leakage. Deep venous thrombosis was not aneurysm was admitted with a pulsatile haematoma present. Laboratory tests revealed a white blood cell in his left thigh that had progressively expanded durcount of 17 800/mm 3 and a haemoglobin concentration ing the previous 4 days. He was haemodynamically of 7.5 g/dl. A few hours after admission the rightstable. On physical examination a pulsatile haematoma sided aneurysm ruptured, causing an expanding with visible bruising was present in the posterior and haematoma in the posterior thigh. Emergency exmedial aspect of his left thigh up to the buttock. ploration through a medial approach confirmed the presence of a 6-cm ruptured aneurysm in the lower segment of SFA. The aneurysm had a wide neck

European Journal of Vascular and Endovascular Surgery, 2013

WHAT THIS PAPER ADDS A hybrid endovascular/open surgical technique, using an endograft connector to simplify anastomoses, is presented for the treatment of true and selected false aneurysms of the common femoral artery. This technique is especially useful when there is proximal extension to involve the external iliac artery. This procedure can be performed under local anaesthesia with sedation. It avoids extensive circumferential arterial dissection and cross-clamping as well as the need for retroperitoneal or transperitoneal exposure. Treatment is thereby simplified and complications reduced.