Degenerative Aneurysms of the Superficial Femoral Artery

Femoral artery aneurysms

True aneurysms are dilatations of blood vessels, bounded by the tunica intima, tunica media and tunica adventitia. False aneurysms are dilatations bounded by the tunica adventitia only, and are more common than true aneurysms. The femoral artery is the second most common location for true peripheral artery aneurysms, and the most common site of false aneurysms. If left untreated, devastating complications can occur, such as infection, rupture, ischaemia and limb loss. Femoral artery aneurysms should be identified early and managed by a vascular specialist. This article outlines the evidence for the epidemiology, investigation and management of femoral artery aneurysms.

Differential Diagnosis of Multiple Systemic Aneurysms

Atherosclerosis and systemic hypertension are the most common pathogeneses of solitary acquired arterial aneurysms. The rare occurrence of multiple synchronous or metachronous arterial aneurysms requires considering alternative underlying causes. We present the unusual case of a male patient who sequentially developed multiple co-existing arterial aneurysms between the ages of 51 and 59. The sites of involvement included high-pressure systemic arteries and low-pressure pulmonary arteries. We discuss the broad differential diagnosis that includes heritable and non-inheritable etiologies. A keen clinical awareness of this broader array of arterial aneurysms is essential for accurate early diagnosis and proper management.

Arteriomegaly with synchronous true aneurysms; Management of Common Femoral Artery and Profunda Femoris Artery aneurysms in a 70-year-old male – A case report

Introduction and importance

Arteriomegaly is characterized by an abnormal elastic defect of arterial vessels, which causes them to become elongated and tortuous. This raises the risk of limb loss due to thromboembolism, bleeding, infection, aneurysmal degeneration, dissection, or rupture. Despite asymptomatic presentations, surgical intervention could be warranted to plummet the morbidity and mortality associated with this pathology.

Case presentation

We report the case of a 70-year-old male who presented with intermittent claudication in the left lower limb at a 100 m. Clinical examination revealed a pulsatile mass in the left groin with absent pulses in the left Popliteal and Pedal arteries. Radiology demonstrated a diffuse enlargement of the Abdominal Aorta with an infrarenal AAA, a L-CFA aneurysm, and a L-PFA aneurysm accompanied by occlusion of the L-SFA. Open surgical repair was achieved.

Clinical discussion

Our patient was managed by arterial ligation and surgical excision of both concomitant aneurysms where we placed a Dacron graft from the L-CIA to the branch of the L-PFA whilst placing a supported ePTFE graft from the previously mentioned Dacron graft of the deep femoral branch to the left below-knee Popliteal Artery.

Conclusion

Arteriomegaly is considered an exceptionally rare and progressive disease. Patients affected by this pathology have higher incidence rates of aneurysmal degeneration and even loss of the affected limb, especially if it's a peripheral aneurysm. Bypass surgical repair is feasible with positive outcomes, and it is prophylactic against the wide spectrum of dire consequences for patients.

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Arteriomegaly is the vascular ectasia of arteries which may or may not be accompanied by aneurysms.

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Aneurysms are an abnormal expansion in the lumen diameter of arteries of 1.5 times the original diameter.

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The incidence of Arteriomegaly ranges from 1.6%–11% as an incidental finding in patients getting lower extremity imaging.

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FAAs are rare and constitute merely 3.1% out of the total number of arterial aneurysmal repair surgeries.

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Elective surgical repair of asymptomatic FAAs of a diameter larger than 25 mm is the gold standard.

A rare case of spontaneous superficial femoral artery pseudoaneurysm in a young patient: case report and review of literature

Spontaneous femoral artery pseudoaneurysm (PSA) is a rare disease and there are few reported cases. We report a case of a 17-year-old male with increasing left leg pain associated with swelling at the site of the pain. We observed a voluminous pulsatile mass. He had no history of trauma or surgery. Imaging confirmed a large PSA of the proximal portion of the left superficial femoral artery (SFA). The PSA was treated by resection of the aneurysm, reconstruction with inter-positional saphenous vein graft. Three months later; he came back to the emergency room for a pulsatile mass. The scan showed a PSA of his left SFA and a hematoma with active bleeding. It was treated surgically by resection of the aneurysm and reconstruction with graft.

Incidence, Diagnosis, Treatment, and Outcomes of True Superficial Artery Aneurysms

BACKGROUND

True superficial femoral artery aneurysms (SFAAs) do not occur frequently but carry a high risk of limb loss when they are complicated with thrombosis, distal embolization or rupture. Large aneurysms can also exert a mass effect, compressing adjacent veins and nerves. We performed an updated review of the literature with regard to their incidence, diagnosis, treatment, and outcomes over the years.

METHODS

A MEDLINE, Excerpta Medica Database (EMBASE) search of papers reporting SFAAs was conducted. Studies reported in the literature were considered for the review regardless of their nature and the number of participants. The available data regarding patient demographics, method of diagnosis, size, location, clinical presentation, therapy, and outcomes were examined.

RESULTS

Searching from 1967 to the present, we identified 59 papers reporting true SFAAs. Forty-one papers were case reports with 1 case each, 9 papers with 2 cases each and 9 papers reporting case series with more than 3 cases. There was 1 study reporting data on the management of asymptomatic SFAAs. We identified 164 SFA aneurysms, and 84.4% were symptomatic. The mean age of patients at the presentation was 70.2 years (range, 27-96) and 89.4% were men. SFAAs were diagnosed earlier in patients with connective tissue disorders, with a mean age of 35 years (range, 29-43). In 60.2 % of cases are present symptoms related to mass compression, 26,8% with rupture, and 27,3% of cases with ischemic symptoms. Endovascular approach was chosen in 52.6% of SFAAs reported in the last 5 years.

CONCLUSIONS

The data in the available literature are poor regarding the management of asymptomatic aneurysms, and the conclusions are based mainly on the symptomatic aneurysms reported. Most SFAAs present mainly with symptoms due to mass compression and rupture rather than ischemic symptoms. The endovascular approach is becoming more popular and could become the preferred choice.

Endovascular treatment of a ruptured true superficial femoral artery aneurysm

Isolated true aneurysms of the superficial femoral artery are rare and less common than those of the common femoral artery. They occurred commonly in elderly men in about 87% and most of them are located in the middle third of the artery. Due to the deep anatomic location of the middle and distal third of the superficial femoral artery, most of these aneurysms reach a mean diameter of 8.4 cm at diagnosis. The most common clinical presentation includes a pulsatile thigh mass associated with pain, but rupture and distal ischemia can occur as well. The treatment of the true superficial femoral artery aneurysm consists of exclusion with bypass or interposition graft. Endovascular treatment has been used recently as an alternative treatment, in both emergency and least urgent cases. We present a rare case of a male patient with a huge thigh hematoma due to a ruptured true superficial femoral artery aneurysm.

Irreversible Limb Ischemia Due to Embolizing Aneurysm of the Superficial Femoral Artery

BACKGROUND

Degenerative superficial femoral artery aneurysms are rare and can lead to catastrophic complications; among these, rupture is the most usual, whereas peripheral embolization is less common.

METHOD

We report a patient with a large superficial femoral artery aneurysm presenting with irreversible limb ischemia, due to multiple distal embolization as demonstrated with urgent computed tomography angiography. Due to local and systemic consequences primary limb amputation was performed. Unfortunately, the patient died from cardiac arrest on the 2nd postoperative day.

CONCLUSION

Delayed diagnosis of true superficial femoral artery aneurysms can result in life-threatening consequences. Peripheral embolization is an uncommon event, but can lead to irreversible ischemia and limb loss.

Endovascularly Treated Superficial Femoral Artery Aneurysm Rupture Secondary to Campylobacter fetus Bacteremia: A Case Report

Degenerative aneurysms of the superficial femoral artery (SFA) are relatively rare and often recognized when they become symptomatic such as rupture. Infected SFA aneurysms are much rarer, especially those caused by Campylobacter fetus bacteremia. We report a case of a 67-year-old woman referred to our hospital owing to the presence of a painful reddish swelling on her left thigh. A huge SFA aneurysm rupture was diagnosed, and endovascular treatment with a covered stent was performed. C. fetus was detected in the blood culture thereafter, and antibacterial therapy was successfully performed without any additional surgical interventions. She remained well without any evidence of indolent infection 19 months after the endovascular treatment. The endovascular approach with appropriate prolonged antibacterial therapy would be a feasible alternative for managing selected infected aneurysm cases.

Delayed presentation of superficial femoral artery pseudoaneurysm 45 years following gunshot injury

This case report is a description of an uncommon delayed presentation of penetrating trauma of lower limb with history of inciting event being 45 years ago, as there are only 4 such reported cases in the literature. A 65-year-old male presented with progressive enlargement of swelling over the anterior aspect of the right thigh with difficulty in walking due to mechanical effects and paraesthesia in the affected limb. Clinical signs of a large lump in the right anteromedial thigh with no pulsations were present. Computerised tomographic angiography revealed the presence of a superficial femoral artery pseudoaneurysm. The open surgical management involved resection of the pseudoaneurysm and autologous vein patch angioplasty. The rarity of incidence and paucity of physical signs suggest that a high index of suspicion, careful clinical review and radiological investigation is indispensable to diagnose and treat this condition.

A Synchronous Ipsilateral True Superficial Femoral Artery and Profunda Femoris Artery Aneurysm With Rupture: A Case Report and Review of the Literature

Atherosclerotic true aneurysms of the superficial femoral artery (SFA) and profunda femoris artery (PFA) are rare and difficult to detect. The synchronous presence of SFA and PFA aneurysms is even rarer. Herein, we present a case with ipsilateral true SFA and PFA aneurysms diagnosed with rupture. A review of the international literature is made, and the diagnosis and treatment options of this rare condition are discussed. A 75-year-old male was admitted to our hospital with an aneurysm on the distal SFA and the ipsilateral PFA, as well as a hematoma around the PFA. It was difficult to determine the source of the rupture before surgery, even with proper imaging. Successful ligation of the PFA and an aneurysmectomy followed by a bypass grafting for the SFA were performed. An intraoperative examination revealed that the SFA aneurysm had ruptured. In elderly males with a history of ectasia or aneurysm on the aorta or peripheral arteries, a synchronous aneurysm on the SFA or the PFA should be suspected.

Rare case of isolated true aneurysm in the superficial femoral artery treated with endovascular intervention: a case report

Background 

Isolated true aneurysms in the superficial femoral artery (SFA) have rarely been reported. Most cases are undiagnosed until rupture or the occurrence of complications.

Case summary

A 36-year-old woman presented with a palpable, pulsating mass on her right thigh which had increased in size over 2 months. She also had a swollen right leg and mild claudication (Stage II in Rutherford classification). For 2 months, the patient was treated by manual massage, acupuncture, and extracorporeal shock wave therapy in local clinics. Bed-side ultrasonography identified a 3.4-cm sized true aneurysm of the right SFA. There were no other aneurysms in arteries from head to toe. There was no evidence of atherosclerotic risk factors or connective tissue disease. The patient was successfully treated by a covered stent graft implantation without any complications.

Discussion

Isolated true aneurysm in the SFA is rare and tends to go undiagnosed especially in young women. Ultrasonography is an easy and useful diagnostic tool for differential diagnosis of thigh mass. In this case, endovascular treatment was safely applied for a true aneurysm without rupture.

Spontaneous rupture of superficial femoral artery aneurysm: case report

Isolated true aneurysms of the superficial femoral artery (SFA) are rare, accounting for 0.5% of peripheral aneurysms. The literature up to 2012 contains reports of just 103 patients with isolated SFA aneurysms. The main complications are thrombosis, distal embolization, and rupture, which is the most common of the three. The authors report the case of a 55-year-old male patient admitted to the emergency service with pain and a pulsatile mass in the left thigh, subsequently confirmed as rupture of an SFA aneurysm. The patient underwent open aneurysm repair with ligature and revascularization with a reversed saphenous vein bypass.

Femoral Artery Aneurysm Repair in a Patient With a Fibrillin-2 Mutation

Degenerative femoral artery aneurysms are uncommon and often associated with aneurysm in other distributions. We report a case of a 68-year-old man with multianeurysmal disease involving the aorta, iliac, femoral, and popliteal arteries managed interdisciplinary by stent-graft placement and open surgical repair. Genetic testing revealed a variant in the FBN2 gene encoding fibrillin-2, an important component of microfibrils. We detail arterial reconstruction of the femoral artery and discuss incidence, diagnosis, and therapy of femoral artery aneurysms.

Aneurisma isolado de artéria femoral superficial roto contido: relato de caso

Aneurismas verdadeiros isolados da artéria femoral superficial (AFS) são eventos raros. Manifestam-se principalmente em homens idosos e frequentemente estão associados a outros aneurismas. Possuem etiologia variada e costumam ser detectados quando apresentam complicações como trombose, embolização distal ou, mais raramente, ruptura. O presente caso refere-se a um paciente cujo aneurisma de AFS se apresentou roto contido e sem associações com outros aneurismas. Foram realizados eco-Doppler colorido arterial, que diagnosticou a ruptura, e angiotomografia, que evidenciou aneurisma sacular de AFS medindo 11,4 × 8,8 cm, com grande trombo mural. Uma arteriografia foi utilizada para programação de revascularização, e detectou-se leito distal via artéria tibial anterior. O paciente foi submetido a revascularização cirúrgica convencional eletiva em artéria femoropoplítea distal com veia safena ipsilateral invertida, com sucesso. Apresentou como complicação pós-operatória infecção de sítio cirúrgico. A pesquisa microbiológica teve resultado negativo, e o estudo anatomopatológico confirmou aneurisma verdadeiro da AFS.

Giant true aneurysm of superficial femoral artery in patient with multiple atherosclerotic aneurysms: A case report

True atherosclerotic aneurysms of superficial femoral artery (SFA) are rare and often associated with other peripheral or aortic aneurysms. We report the case of a 84-year-old patient presenting a giant degenerative ruptured aneurysm of the superficial femoral artery. The patient underwent successful aneurysm resection and bypass grafting, with a satisfying long-term follow-up and patency of the graft. The patient was also operated one year before, for a ruptured aneurysm of the abdominal aorta. This case report is rare, because we described a case of patient with multiple atherosclerotic aneurysms, who present, for the second time, a life threating ruptured aneurysm. In this report, we see extreme and rapid evolution of SFA Aneurysm before being symptomatic. Degenerative aneurysms of the lower extremity most commonly involve the popliteal artery, while they are rarely detected in the femoral region (Leon et al., 2008). In this region, aneurysms most frequently involve the common femoral artery (CFA), whereas true aneurysms of the superficial femoral artery (SFA) represent only 15% to 25% of femoral arterial aneurysms [1-5]. Degenerative aneurysms of the SFA display peculiar characteristics (in terms of clinical onset, diagnostic timing, and clinical behavior) so that they differ from other peripheral aneurysms. Because the relative rarity of this location, our case report can be useful to participate to increase the number of reported cases, and define the therapeutic approach for this rare location.

Ruptured superficial femoral artery aneurysm: a case report

A 96-year-old male presented with left lower extremity pain, swelling, and vascular compromise. Computed tomographic angiography revealed an actively rupturing distal superficial femoral artery aneurysm. The patient underwent prompt aneurysm excision with graft interposition and had a successful postoperative outcome. Our case illustrates the critical role of imaging in establishing a definitive diagnosis and preventing mortality.

A ruptured superficial femoral artery aneurysm: A case report

True atherosclerotic aneurysms of superficial femoral artery (SFA) are rare and often associated with other peripheral or aortic aneurysms. We are reporting the case of a 78-year-old man who has been admitted with a ruptured superficial femoral artery aneurysm associated with bilateral popliteal artery aneurysm. The patient underwent successful aneurysm resection and bypass grafting.

Ruptured true superficial femoral artery aneurysm

Femoral artery aneurysms are rare and generally affect elderly patients. They are often diagnosed in combination with aneurysms in other locations, such as peripheral and aortic aneurysms. This case report describes a young patient whose superficial femoral artery (SFA) had a clinical presentation suggestive of a ruptured aneurysm. The patient underwent standard treatment, with aneurysmectomy and interposition of the ipsilateral saphenous vein. A review of the literature confirms the rarity of this case

Hygroma following endovascular femoral aneurysm exclusion: A case report

INTRODUCTION

Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory.

PRESENTATION OF CASE

A complication due to endovascular stent-graft treatment in an 80-year old male with a 6 cm aneurysm in the SFA is presented. Hygroma developed after a partially unintended extravascular placed stent-graft. Two consecutive explorations resulted in a femoro-popliteal Polytetrafluoro-ethylene (PTFE) by-pass graft as the final solution.

DISCUSSION

Several explanations for the patient's complications are suggested.

CONCLUSION

A primary femoral-femoral/popliteal by-pass might be the best solution in SFA aneurysms due to risk of stent complications.

Peripheral arterial aneurysms: open or endovascular surgery?

Peripheral arterial aneurysms are uncommon; for some aneurysm types, data are limited to case reports and small case series. There is no Level A evidence in most cases to determine the choice between open or endovascular intervention. The evolution of endovascular technology has vastly improved the armamentarium available to the vascular surgeon and interventionalists in the management of these rare and unusual aneurysms. The choice of operative approach will ultimately be determined on an individual basis, dependent on the patient risk factors, and aneurysm anatomy. After consideration, some aneurysms (femoral, subclavian, carotid and ECAA) fare better with an open first approach; renal, splenic and some visceral artery aneurysms do better with an endovascular first approach. In our practice PAAs are treated with an endovascular first approach. For these rare conditions, both open and endovascular therapy will continue to work in harmony to enhance and extend the capabilities of modern surgical management.

Aneurisma de artéria femoral superficial roto: relato de caso e revisão de literatura

O aneurisma de artéria femoral superficial é um evento raro que costuma manifestar-se em pacientes com idade avançada, frequentemente associado a outros aneurismas, periféricos ou de aorta abdominal. O caso relatado refere-se a um paciente cujo aneurisma de artéria femoral superficial se apresentou roto e associado a um aneurisma de aorta abdominal. Foi submetido à revascularização cirúrgica fêmoro-poplítea mediante prótese de politetrafluoretileno, com sucesso. A revisão da literatura demonstra que embora haja uma tendência à manifestação aguda da doença, principalmente como ruptura, os resultados com o tratamento cirúrgico são excelentes.