Aneurysms of the superficial femoral artery: A report of two cases and review of the literature

Abstract

True “arteriosclerotic” aneurysms of the superficial femoral artery, not associated with generalized dilatation of the common femoral or popliteal artery, are relatively rare. We report our experience with two isolated superficial femoral artery aneurysms and review the previous literature. An 88-year-old woman was first seen with thrombosis of a superficial femoral aneurysm and limb-threatening ischemia and had eventual limb loss as a result of occlusion of distal run-off vessels despite surgical revascularization. A 93-year-old man came to us with rupture and was treated with an interposition graft, which resulted in limb salvage. Review of 17 “arteriosclerotic” superficial femoral artery aneurysms in 14 patients whose cases were reported in the literature revealed a complication at presentation in 65%, rupture in 35%, thrombosis in 18%, and distal emboli in 12%. However, limb salvage was 94% and there were no perioperative deaths. Abdominal aortic aneurysms were discovered in 40%. Males (75%) were more common than females, and the average age was 77 years (range 61 to 93). Isolated superficial femoral artery aneurysms are rare and occur at an older average age than do other peripheral aneurysms, but their incidence is anticipated to increase with this growing segment of our population. In the absence of evidence of syphilitic, other infectious, immunologic, inflammatory, or connective-tissue disorders, these and other aneurysms are considered arteriosclerotic in origin, despite the absence of diffuse arteriosclerosis in many cases and controversy regarding the role of arteriosclerosis in their cause. Because of the rarity of superficial femoral artery aneurysms, there is frequently a delay in diagnosis, and they are first noted with rupture more often than are other peripheral aneurysms. The incidence of critical ischemia as a result of thrombosis or emboli is similar to that associated with other peripheral aneurysms. Superficial femoral artery aneurysms are associated with abdominal aortic aneurysms, as are other peripheral aneurysms. Successful preservation of life and limb is possible with early recognition and surgical reconstruction, which is recommended for patients with aneurysms of the superficial femoral arteries that are 2.5 cm or greater in maximum diameter and for symptomatic aneurysms of any size.