Femoral Aneurysm Research Articles

Recurrence of femoral anastomotic aneurysms

Forty-two noninfected femoral anastomotic aneurysms that occurred after aortobifemoral bypass were repaired during a 7 year period. Twenty of these were recurrent aneurysms. In an attempt to define the cause of recurrence, a number of factors were studied including infection, suture failure, graft deterioration, defective graft manufacture, graft dilatation, and arterial degeneration. Five grafts in the primary group failed because of inherent defects in the graft structure. Two lightweight Dacron grafts showed generalized graft dilatation, and three unwrapped expanded polytetrafluoroethylene grafts had linear tears at the anastomosis. We believe that such graft degeneration does not represent a current problem because the polytetrafluoroethylene grafts now used are reinforced, and lightweight Dacron grafts are no longer made. Two primary femoral anastomotic aneurysms resulted from broken polypropylene suture. No infections were found in the primary or recurrent groups of aneurysms. Arterial degeneration adjacent to the anastomosis, consisting of a decrease in wall thickness due to loss of smooth muscle with proliferation of elastic fibers and disruption of elastic laminae, was a consistent finding in the remaining 15 primary femoral anastomotic aneurysms and all recurrent femoral anastomotic aneurysms. In many instances of primary femoral anastomotic aneurysm and in all instances of recurrent aneurysms dilatation of the Dacron graft with secondary arterial degeneration was believed to be the cause of aneurysm formation. Graft dilatation without fiber deterioration is an inherent problem in Dacron grafts and reportedly varies from 10 to 50 percent of the original graft diameter. This dilatation plus the use of initial graft diameters larger than the host artery leads to increased tension at the anastomotic site with subsequent arterial degeneration. For the aforementioned reasons, our current practice and recommendation is that repair of all anastomotic aneurysms be with expanded polytetrafluoroethylene grafts sized to approximate the host artery since its dilatation at sites of arterial pressure is minimal.

Management of Femoral Pseudoaneurysms

The most common type of femoral false aneurysm is anastomotic; the second most common type is traumatic, having an iatrogenic origin. Noninfected femoral false aneurysms of 2 cm or less can be watched and operated upon when they show growth. The operative technique of false aneurysmorrhaphy varies according to the problems of the particular patient.

Manifestations of Kawasaki disease in New England outbreak of 1980

Twenty-five children with Kawasaki disease were studied during the spring of 1980. All had fever, rash, conjunctivitis, and at least two of the remaining three diagnostic criteria. They ranged in age from 7 months to 10 years with an average of 3.2 years. Cardiac manifestations were present in 64%; one had a myocardial infarct, and two had coronary aneurysms, with iliac and femoral aneurysms as well in one of these. Shock requiring dopamine therapy occurred in two; congestive failure requiring digoxin and furosemide occurred in these two and in four others. Many other problems, including hydrops of gallbladder, meningoencephalitis, cranial nerve palsies, and hypertension were also present. Thrombocytopenia occurred in two transiently, and in one of them signs suggestive of hemolytic-uremic syndrome were also present. This experience was gained during largest outbreak of Kawasaki disease yet reported in the United States.

Peripheral venous aneurysms with recurrent pulmonary embolism: Report of a case and review of the literature

This clinical report deals with a femoral venous aneurysm as a source of recurrent pulmonary embolism. The literature concerning venous aneurysms is reviewed with emphasis on those cases which were complicated by venous thrombosis and pulmonary embolism. This case demonstrates that lower leg venous aneurysms can occur in either sex and in different age groups. Venography was shown to be important in diagnosing these lesions. Surgical resection may be necessary to prevent potential thrombosis and life-threatening pulmonary embolism.

A New Method for the Treatment of False Femoral Aneurysms

A new technique for repairing anastomotic femoral aneurysms is de scribed.The procedure consists of initial exposure and control of the graft limb through a suprainguinal incision, and control of the common femoral artery and its branches by insertion of Fogarty catheters into the individual lumens. This technique has been used successfully in 3 patients.

Femoral anastomotic aneurysms.

Both the literature and this experience support host vessel degeneration as the primary etiologic factor in femoral anastomotic aneurysms. Associated factors that produce increased "intra-anastomotic tension," such as hypertension, superficial femoral artery occlusion, and flow turbulence, appear to contribute to vessel deterioration. Other factors, much less prevalent in present-day vascular surgery, such as rigid grafts, deficient suture material, inappropriate angle of incidence, and excessive tension on the graft can contribute to anstomotic disruption. Certain guidelines may be helpful in the management of femoral pseudoaneurysm. 1) Redo the entire anstomosis, rather than simply resuturing a disrupted edge. 2) Use minimal dissection to avoid injury to outflow vessels and to limit disruption of supportive tissue. 3) Use braided synthetic suture material. 4) Avoid tension by interposing a segment of graft between the proximal graft limb and the host vessel. 5) Use knitted Dacron for the interposed segment so the new anastomosis to the host vessel will be with softer, more pliable fabric. 6) Assure smooth adequate outflow by end-to-end anastomosis with a patch angioplasty or distal bypass. These guidelines should lead to a safe, reliable solution to one of the vexing complications of aortofemoral bypass procedure.

Clinical Significance of Arteriosclerotic Femoral Artery Aneurysms

One hundred seventy-two arteriosclerotic femoral artery aneurysms in 100 male patients, 47 to 91 years old, were evaluated. They were bilateral in 72% of the patients, and were associated with aortoiliac aneurysmal disease in 85% and with popilteal artery aneurysms in 44%. Femoral artery aneurysms were asymptomatic in 40 patients. Thirteen patients with thromboembolic episodes and two with rupture had ischemic limbs. Thirty-eight patients underwent primary operation for 50 femoral aneurysms, including 36 lower extremity arterial reconstructions, ten aortofemoral bypasses, one arterial ligation, and three amputations. Two operative deaths occurred, both associated with concomitant aortic surgery. Only three of 105 aneurysms in 58 patients followed nonoperatively were associated with later major limb-threatening complications. The low complication rate attending small, bland aneurysms justified nonoperative management. Large or symptomatic aneurysms warrant early operative intervention.

External herniae: ventral herniae and summary.

1. In three articles, inguinal, femoral, and ventral herniae have been discussed, one of the aims being to draw the attention of those who are new to surgery in the tropics to some of the things the author thought were peculiar to these herniae. Experiences in the 1,100-bed Korle Bu Hospital, Accra, where a retrospective survey showed that 609 external herniaw were mended in 15 months, formed the basis of the discussions. 2. The applied anatomy of the inguinal canal of adult Ghanaians was described. Three things were pointed out: the infantile type of inguinal hernia was the rule not the exception; the floor and the conjoint tendon were well developed and useful for repair; the pubic branch of the inferior epigastric artery was normal not aberrant. 3. IN Accra inguinal herniae are big and a man's disease. The differential diagnosis of scrotal hernia includes vaginal hydrocele, scrotal elephantiasis, testicular tumours, and tuberculous epididymoorchitis. A case was made in favour of differentiating between direct and indirect inguinal herniae preoperatively. 4. Elective herniorrhaphy was recommended as the treatment of choice and operative techniques were described. The suture material to employ for the Bassini repair must be non-absorbable, e.g. silk or nylon. Whereas herniotomy is adequate in children, in women herniorrhaphy is combined with clearance and obliteration of the inguinal canal. 5. The author did not recommend a truss for an inguinal let alone a femoral hernia. There is suggestive evidence that even in the tropics a man's hernia could be safely repaired on an out-patient basis. 6. Since femoral hernia is rare, it was recommended that in the interest of the patients, skillful surgeons should repair them. 7. The surgical anatomy of the femoral canal, and clinical features of femoral hernia were described. The differential diagnosis included inguinal hernia, abscesses in the groin, hydrocele of the femoral canal, saphena varix, lymphadenopathy, simple tumours and aneurysm of the femoral artery. 8. The treatment of choic is a surgical operation of which three were named and one described ("the low" operation of Lockwood). Recurrence is rare...

Multiple arteriosclerotic arterial aneurysms.

Among 1,488 patients with arteriosclerotic aneurysms of the abdominal aorta and its peripheral branches seen at the University of Michigan Medical Center from 1960 to 1971, 57 (3.9%) had multiple arteriosclerotic aneurysms. Multiple aneurysms occurred in 83% of patients who had at least one peripheral aneurysm. Among the 37 patients with a common femoral aneurysm, 95% had a second aneurysm, 92% had an aorto-iliac aneurysm, and 59% had bilateral femoral aneurysms. Among the 36 patients with a popliteal aneurysm, 78% had a second aneurysm, 64% had an aorto-iliac aneurysm, and 47% had bilateral popliteal aneurysms. The importance of suspecting a nonpalpable aorto-iliac aneurysm in the presence of a peripheral aneurysm, and the usefulness of arteriography are emphasized. Planned staged resection and careful followup are required to manage these patients successfully.

Femoral artery reconstruction under local anesthesia: Maximal results for minimal risk

Femoropopliteal occlusive vascular disease is generally managed with an operative procedure which employs saphenous vein bypass or endarterectomy. In some patients, however, the predominant occlusion involves the common and deep femoral arteries as well as the superficial femoral artery. These patients frequently have had aortofemoral bypass or aortoiliac endarterectomy prior to the development of incapacitating leg claudication or rest pain. Consistent with the diffuse nature of the disease process, they often have had single or multiple myocardial infarctions and are relatively poor operative risks. In the past year we have successfully managed five such patients with predominantly femoral occlusive disease, femoral occlusive disease, or femoral false aneurysm. (Table I.) The principal objective in each patient was local endarterectomy of the diseased femoral system with emphasis on establishing improved flow to the deep femoral artery. In two patients, resection of a false aneurysm of the femoral artery was performed in conjunction with local endarteredomy. In an attempt to’ save the saphenous vein for possible future use, reconstruction’ was performed with patch angioplasty using the antecubital vein or a piece of endarterectomized artery from a totally occluded superficial femoral artery. All patients were operated op under local anesthesia. We have been impressed with the versatility, extensive amount of reconstruction, and favorable clinical results obtained with this approach. In a further attempt to reduce operative risk, blood autotransfusions were given during operation and postoperatively in three patients.

False Femoral Aneurysm following Percutaneous Retrograde Renal Arteriography

False Femoral Aneurysm following Percutaneous Retrograde Renal Arteriography

Femoral Aneurysms

A study was made of femoral aneurysms occurring in 89 patients from 1950 through 1963. True aneurysms were bilateral in 36% of the patients and multiple in 69%; associated aneurysms involved the popliteal and iliac arteries and the abdominal aorta. Complications were primarily passive venous congestion and occlusive arterial disease. Forty-four of the 89 patients were not considered surgical candidates, often because associated disease made the risk prohibitive. The remaining 45 patients underwent 52 operations. Elective surgery is considered appropriate in the management of femoral-arterial aneurysms when they are of significant size, when the surgical risk is reasonable, and when distal vessels provide sufficient run-off to maintain patency of the graft.

Sudden complete thrombosis of an aneurysm of the abdominal aorta.

THE complications of aneurysm of the abdominal aorta have frequently been discussed, but sudden occlusion has not been included among them. Spontaneous rupture into the retroperitoneal space,1 , 2 the peritoneal cavity3 or adjacent organs4 5 6 7 8 has repeatedly been seen, as has dissection, with its various complications.9 10 11 12 13 Emboli, too, are seen, but sudden total thrombosis is very rare even though it is frequently observed in peripheral aneurysms. Popliteal aneurysms are notoriously apt to thrombose, and femoral aneurysms also may suddenly occlude.14 15 16 This is not true, however, of aneurysms involving the aorta. Indeed, surgeons attempted to effect thrombosis of the aneurysm or at least . . .

Results of major arterial grafting.

Introduction The symptom of intermittent claudication is due to inadequate blood supply to the claudicating muscles. The symptom of claudication and the physical finding of absence of pulses in the proper location establish a clinical diagnosis of arteriosclerosis obliterans. The location of the occlusion, its anatomic detail, and the collateral pattern are demonstrated by angiology. Approximately 50% of all cases of arteriosclerosis obliterans are amenable to treatment by arterial graft. All abdominal, femoral, and popliteal aneurysms are amenable to treatment by arterial graft. The results of grafting in 300 consecutive patients are analyzed as to current results and are presented. In general, it may be stated that between 80% and 85% of patients treated by arterial graft are entirely rehabilitated. 2020 E. 93d St. Cleveland Clinic

Bilateral mycotic femoral aneurysms; report of a case with some remarks on mycotic aneurysms in general.

Bilateral mycotic femoral aneurysms; report of a case with some remarks on mycotic aneurysms in general.

Ruptured Aneurysm of the Superficial Femoral Artery

Femoral arterial aneurysms are rare, but their existence must be considered in cases of acute ischaemia of the leg or the occurrence of a pulsating swelling in the groin. Surgical intervention is mandatory, and venous autografts should be preferred to synthetic grafts. With adequate therapy, the prognosis is favourable, but the coexistence of multiple aneurysms should always be borne in mind. A successfully treated case of ruptured femoral aneurysm, combined with abdominal aortic aneurysm, is reported.

A case of surgery on a patient with arteriovenous femoral aneurysm

Abstracts. Internal illnesses. Prof. Eduard Melchior (Medic. Klin. No. 13, 1929) gives a successful case of operating a patient with an arteriovenous femoral aneurysm (a fistula between A. and V. femoralis), which arose 10 years before surgery on the basis of injury and also caused anatomical changes in the heart, disappeared after the operation.

Proving the Collateral Circulation in a Case of Femoral Aneurysm by the Henle-Coenen Sign

Proving the Collateral Circulation in a Case of Femoral Aneurysm by the Henle-Coenen Sign

WESTMINSTER HOSPITAL.: DIFFUSED FEMORAL ANEURYSM ; LIGATURE OF EXTERNAL ILIAC ARTERY; RECOVERY

WESTMINSTER HOSPITAL.: DIFFUSED FEMORAL ANEURYSM ; LIGATURE OF EXTERNAL ILIAC ARTERY; RECOVERY