Superficial Femoral Artery Aneurysm Research Articles

Treatment of true superficial femoral artery aneurysms: the 15-year experience of a single centre.

True superficial femoral artery aneurysms (SFAAs) are rare and traditionally treated by open repair. However, the endovascular approach excluding the aneurysm sac with a covered stent may be an alternative. This study aimed to compare the outcomes of the open and endovascular repair of SFAAs. This is a retrospective, observational, monocentric study. The main endpoints were: technical success, limb salvage and primary patency rate, and hospitalisation time. We identified 49 SFAAs in 40 patients; the mean age was 73.3±10.1 years, the mean diameter of SFAAs was 5.41±3.64cm, and 61.2% were symptomatic for ischaemic or compression-related signs. The indication for open repair was given mainly for complex SFAAs involving the distal third of the superficial femoral artery and with an ipsilateral popliteal aneurysm. Among the 36 open-repair patients, 33 underwent ligation and revascularisation via bypass or graft interposition, and 3 patients underwent simple ligation without revascularisation. The endovascular approach was adopted mainly for aneurysms located in the medial third of the SFAA, which underwent covered stenting in 12 patients and coil embolisation in 1 patient. The technical success was 100% in all cases. There were no statistical differences in terms of primary patency and limb salvage rate between groups at two and four years. The mean hospitalisation time was 10±4 and 3±1 days after open and endovascular treatment, respectively. The endovascular approach may be a valid alternative for isolating SFAAs offering good results and shorter hospitalisation. Open repair remains a valid approach, particularly in complex aneurysms.

Anesthetic management of external iliac artery transection in a morbidly obese patient with Klippel-Trenaunay-Weber syndrome: a case report

BackgroundWe report the anesthetic management of an external iliac artery transection in a morbidly obese patient with Klippel-Trenaunay-Weber syndrome (KTWS).Case presentationA 47-year-old man with KTWS was scheduled for a right external iliac artery transection. Preoperative CT showed a right external iliac artery aneurysm, a right superficial femoral artery aneurysm, and developed collateral vessels. General anesthesia was maintained with desflurane, remifentanil, and rocuronium bromide. After the transection of the right external iliac artery, the regional saturation of oxygen (rSO2) value of the right femoral did not decrease. There was no significant hemodynamic change before or after the transection. A non-ultrasound-guided rectus abdominis sheath block was performed due to the many collateral vessels. After extubation, the patient did not complain of postoperative pain.ConclusionsIn the transection of lower-extremity blood arteries under laparotomy in patients with KTWS, rSO2 monitoring, hemodynamic monitoring, and combined regional anesthesia could be useful.

S2128 Rectal Ischemia in a Patient After EVAR and COVID-19

Introduction: Ischemic proctitis is a rare, but serious, source of GI bleeding as mortality rates approach 20-40%. Patients for which ischemia should be considered are those with previous surgery, older patients, and those with known peripheral arterial disease. Case Description/Methods: 80-year-old male with history of hyperlipidemia and hypertension presented to the hospital for shortness of breath secondary to COVID-19 pneumonia. His respiratory status continued to decline requiring mechanical ventilation and ICU admission. During his admission, he was found to have acute left lower extremity ischemia requiring stenting of his superficial femoral artery and abdominal endovascular aneurysm repair (EVAR). He was started on anticoagulation with heparin infusion. His hospital course was further complicated large volume maroon-colored stools concerning for lower GI bleed. Colonoscopy was performed at the bedside to further evaluate. In the rectum, there were circumferential ulcerations with inflammation and exudate, extending 10 cm from the anal verge. Biopsies were consistent with rectal ischemia. Unfortunately, soon after the patient developed worsening acidosis requiring CVVHD and increased requirement for pressor support. The family ultimately decided to pursue comfort care and the patient was palliatively extubated (Figure). Discussion: Rectal ischemia is rare as the rectum has blood supply from the inferior mesenteric and bilateral iliac arteries. In our patient, during EVAR graft repair, the IMA was occluded by a stent, the iliac arteries however, remained intact providing the middle rectal and pudendal artery as sources of collateral blood supply. It is hypothesized that a hypercoagulable state caused by COVID-19 infection coupled with ongoing hypotension in the setting of critical illness in our patient with significant peripheral arterial disease led to the low flow state in bilateral iliac arteries causing ischemic proctitis. Rectal ischemia must be considered early in patients because, while most cases of lower GI bleeding can be treated conservatively, rectal ischemia is an indication for prompt surgical intervention. Surgical intervention is required to remove necrotic bowel and potential sources of infection causing septic shock.Figure 1.: Circumferential rectal ischemia as seen by colonoscopy.

A case of deep femoral artery aneurysm found with superficial femoral artery aneurysm.

Objective: Deep femoral artery (DFA) aneurysms are extremely rare cases of aneurysms that are difficult to diagnose. The objective of this report was to discuss the timing and method of surgery for this disease.Patient: We encountered an asymptomatic left DFA aneurysm that was discovered along with a symptomatic aneurysm of the right superficial femoral artery (SFA). Both sides of the aneurysm were resected with Dacron knitted artificial vascular grafts (Gelsoft™ Plus, Vasctek, UK) simultaneously.Result: After the operation, the right SFA had good blood flow, but the graft of the left DFA was occluded. The occlusion was considered to be caused by insufficient blood flow in the graft. The patient was discharged without any complications.Conclusion: The coexistence of DFA aneurysms should be examined if other aneurysms are found. DFA aneurysms are at a high risk of rupture. Careful follow-up is required, and intervention is recommended when the diameter exceeds 35 mm.

Review of the management of isolated superficial femoral artery aneurysms

Truly isolated aneurysms of the superficial femoral artery (SFA) are uncommon. The treatment options come from small case series and case reports. In the absence of definitive management guidelines, a revision of the available literature was carried out. True SFA aneurysms are more common in elderly male patients and tend to present late and can grow to significant sizes. Both open and endovascular options are available, which will depend on many factors highlighted in this review. Open repair should be offered to fit patients.

Endovascular treatment of the superficial femoral artery aneurysm infected by typhoid Salmonella

Salmonella aortitis accounts for approximately 40% of all infectious aortitis. Superficial femoral artery aneurysm infected by Salmonella typhi has rarely been reported. The study reported a 71-year-old Chinese woman with a previous history of nephrotic syndrome and long-term oral hormone therapy, who was admitted to the hospital with a gradually increasing pulsatile mass in the right thigh and pain. After admission, computed tomography angiography revealed rupture and bleeding of an aneurysm in the middle and lower segment of the right superficial femoral artery (SFA). The aneurysm of the SFA was satisfactorily isolated by the covered stent. The bacterial culture of the secretion from the punctured mass showed the S. typhi infection. Based on the results of the drug sensitivity test, the patient received anti-infective treatment for 4 weeks. The patient recovered well after 1-year follow-up.

Behçet Syndrome and Crohn's Disease: What Are the Differences?

Behçet syndrome (BS) is a variable vessel vasculitis that has pleiotropic manifestations. A 43-year-old male with a previous diagnosis of Crohn’s disease (CD) presented with deep venous thrombosis and bilateral superficial femoral artery aneurysms. A diagnosis of BS was made, and the patient was treated aggressively with immunosuppressive therapy and bilateral bypass surgery, attaining a favourable outcome. CD has many features that overlap with BS, and it may be challenging to distinguish between these two conditions, as our case illustrates. Nonetheless, the combination of venous thrombosis and arterial aneurysms should point the clinician towards a diagnosis of BS.LEARNING POINTSBehçet syndrome is a variable vessel vasculitis of unknown aetiology that has pleiotropic manifestations.Crohn’s disease has many overlapping features with Behçet syndrome, namely gastrointestinal, cutaneous, articular, ocular and cardiac manifestations.The combination of venous thrombosis and arterial aneurysms should point the clinician towards a diagnosis of Behçet syndrome.

Ruptura espontânea de aneurisma do segmento médio da artéria femoral superficial: relato de caso

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.

A rare case of a giant superficial femoral artery aneurysm

A rare case of a giant superficial femoral artery aneurysm

Post-procedural pseudoaneurysms: Single-center experience.

Objectives Pseudoaneurysms are a well-recognized complication of percutaneous angiographic procedures. Ultrasound-guided thrombin injection is currently the preferred treatment modality. This study was undertaken to evaluate our experience with the management of post-procedure pseudoaneurysms. Methods A retrospective study was undertaken of all patients who developed a post-procedure pseudoaneurysm between March 2004 and January 2013. Data were obtained from our prospectively maintained non-invasive vascular laboratory data base. Results Overall, 167 patients (80 men) with post-procedure pseudoaneurysms were identified. The mean age was 66 years. Post-procedure pseudoaneurysms developed following diagnostic coronary angiography (38%), coronary angioplasty (37%), peripheral vascular interventions (14.7%), or other access procedures (7.6%). Mean post-procedure pseudoaneurysm diameter was 2.8 ± 1.8 cm. One hundred forty-two post-procedure pseudoaneurysms were injected with thrombin under ultrasound guidance. Primary success rate was 93.5%. There were 12 (8.5%) procedural failures of which seven (58%) responded to reinjection, three (25%) required operative management, one was treated with ultrasound-guided compression, and one (8.3%) was simply observed. On multivariate analysis, failures were associated with increased aneurysm diameter ( p = 0.006; odds ratio 2.23, 95% CI 1.25 to 3.96), end-stage renal disease ( p = 0.013; odds ratio 1.15, 95% CI 1.09 to 1.78) and superficial femoral artery aneurysm origin ( p = 0.031; odds ratio 0.20, 95% CI 0.04 to 0.86). There were two episodes of thrombus formation in the femoral artery; one resolved with anticoagulation alone, and the other required thrombectomy. Conclusions Percutaneous ultrasound-guided thrombin injection is an effective and safe method for managing post-procedure pseudoaneurysms. Failure rates are low and associated with large aneurysm size, superficial femoral artery origin and end-stage renal disease.

Management of a Ruptured Mycotic Superficial Femoral Artery Aneurysm

Aneurysms of peripheral arteries of the leg like the iliac, superficial femoral or popliteal arteries are quite rare. They often tend to coexist or develop later in other vessels in patients who have been treated at one site. They usually present with symptoms of compression of adjacent structures usually the veins or nerves or by distal embolization of the vessels causing a trash foot. It is extremely rare for them to present with a rupture. If this rare event does occur, one has to have strong suspicion of a mycotic (infected) aneurysm. We present a rare case of a ruptured superficial artery aneurysm and its successful management. J Med Cases. 2016;7(2):66-69 doi: http://dx.doi.org/10.14740/jmc2408w

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.

Yüzeyel Femoral Arterde Aterosklerotik Anevrizmanın Cerrahi Tedavisi

Yüzeyel Femoral Arterde Aterosklerotik Anevrizmanın Cerrahi Tedavisi

The current management of isolated degenerative femoral artery aneurysms is too aggressive for their natural history

Previous studies have combined anastomotic, catheter-induced, and atherosclerotic isolated femoral artery aneurysms (FAAs) to achieve adequate numbers for analysis and have recommended repair of asymptomatic FAAs with diameters ≥2.5 cm and all symptomatic FAAs. This study evaluated the contemporary management of isolated FAAs. Patients with FAAs were evaluated using a standardized, prospectively maintained database by a research consortium. From 2002 to 2012, 236 FAAs were identified in 182 patients (mean age, 72 years; male-to-female ratio, 16:1) at eight institutions. The mean nonoperative mean diameter was 2.8 ± 0.7 cm, and the operative diameter was 3.3 ± 1.5 cm. FAA location was the common femoral artery in 191, superficial femoral artery (SFA) in 34, and profunda femoris artery in 11. Synchronous aneurysms (mean, 1.7 per patient) occurred in the aorta (n = 113), in the iliac (n = 109), popliteal (n = 86), and hypogastric (n = 56) arteries, and in the contralateral common femoral artery (n = 34), SFA (n = 9), and profunda femoris artery (n = 2). Of the aneurysms repaired, 66% were asymptomatic; other indications for repair were claudication (18%), local pain (8%), nerve compression (3%), rupture (2%), acute thrombosis (1%), and rest pain (0.5%). Acute aneurysm-related complications (rupture, thrombosis, embolus) were associated (P < .05) with FAA diameter >4 cm and intraluminal thrombus, but not location. Mean diameter of asymptomatic aneurysms that developed acute complications was 5.7 ± 1.3 cm for rupture, 4 ± 1.1 cm for thrombosis, and 3.5 cm for embolus. Repair was by interposition or bypass graft in 177 FAAs and by endovascular repair in three SFA aneurysms. Two perioperative deaths, of myocardial infarction and multisystem organ failure, occurred at 30 days. Operative complications included wound infection (6%), seroma (3%), and bleeding (2%). No amputations occurred through 5 years in the operative or nonoperative groups. Survival in operated-on patients was 99% (n = 138) at 3 months, 92% at 1 year, and 81% (n = 20) at 5 years. This largest study of isolated FAAs demonstrates that (1) acute complications did not occur in FAAs ≤3.5 cm, repair criteria of asymptomatic FAAs should be changed to >3.5 cm, and chronic intraluminal thrombus should reduce the threshold for repair, and that (2) current indications for symptomatic FAA repair result in low morbidity and should remain unchanged.

Surgical management of isolated superficial femoral artery degenerative aneurysms

To investigate the mode of presentation, diagnosis, association with other aneurysms, operative management, and outcomes of superficial femoral artery (SFA) aneurysms. Records of all patients who underwent surgery for isolated, true SFA aneurysms (not due to infection, vasculitis, or tissue disorders) from 2002 to 2012 in two European centers were retrospectively analyzed. Demographic (sex, age), clinical (cardiovascular risk factors, location of the aneurysm, symptoms, presentation, emergency setting), surgical and radiological data (diameter, surgical technique, runoff vessels patency, presence of aneurysms elsewhere) were obtained for analysis. Follow-up was undertaken with clinical and ultrasound examinations at 1 month, 3 months, 6 months, 12 months, and yearly thereafter. The patency of the graft and the status of the anastomoses and inflow and outflow vessels were assessed. Main end points were represented by 30 days and long-term mortality and amputation-free survival. A total of 27 cases of SFA aneurysm were analyzed. Mean age at operation was 78 years ± 8.5. At presentation, SFA aneurysms were often symptomatic (rupture was present in 7/27 cases and acute distal ischemia in 6/27 cases), large (mean diameter, 54 mm ± 33.1 mm), bilateral (38% of the cases), and associated with aneurysms elsewhere (84%). Sixteen patients underwent resection of the aneurysm and polytetrafluoroethylene interposition graft, seven patients exclusion of the aneurysm with a femoropopliteal bypass (autogenous bypass in five cases, prosthetic in two), three patients simple ligation, and one patient underwent primary amputation. Mean follow-up was 41.47 months (range, 0.43-128.67 months). Early (<30 days) mortality and amputation rate were 4% and 7%, respectively. Estimated 5-year survival, limb salvage, and graft patency rates were 62%, 88%, and 85%, respectively. 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. In fact, they often grow to reach a considerable diameter before medical attention is sought, presenting with rupture or ischemia at diagnosis. SFA aneurysms preferentially affect elderly men and are often associated with aneurysms elsewhere. However, despite their rarity, the treatment is usually feasible, and long-term outcomes are good.

Synchronous Endobypass of Bilateral Superficial Femoral Artery Aneurysms (After Bilateral Popliteal Aneurysm Bypass Surgery) Using Heparin-Bonded Stent-Grafts

Introduction: Bilateral superficial femoral artery aneurysms are a rare entity, managed here via a synchronous endovascular approach. Report: An 84-year-old male presented with bilateral peri-anastomotic superficial femoral artery aneurysms 3 years after femoropopliteal bypass for bilateral popliteal aneurysms. He underwent successful synchronous bilateral endobypass using overlapped 13 × 100 mm (proximal) and 11 × 100 mm (distal) heparin-bonded endoprostheses. Discussion: Calibre mismatch between ectatic vessel and narrower vein graft may be related to peri-anastomotic aneurysm formation in a patient who has a predilection for aneurysm formation. Bilateral superficial femoral artery aneurysms can be managed by synchronous endobypass with the attendant benefits of avoiding repeat admission/anaesthetic episodes.

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

Isolated Superficial Femoral Artery Aneurysm: A Case Study

Introduction Isolated aneurysms of the superficial femoral artery (SFA) are rare, and their etiology is not yet fully understood. Although not as common as abdominal aortic or popliteal artery aneurysms, they pose a serious threat of rupture and/or thrombosis. Because of their atypical presentation, they can be easily misdiagnosed. Methods A 58-year-old man presented with a painful lump over his left medial thigh, first noted 6 months previously. The patient was asymptomatic in regards to claudication. The findings of magnetic resonance imaging suggested a vascular mass versus pseudoaneurysm of the SFA. The patient was referred to the vascular laboratory and underwent duplex evaluation. This revealed an 8.3–cm long SFA aneurysm with a maximum diameter of 5.9 cm with extensive mural thrombus present. Angiography confirmed a true aneurysm, with an estimated length of 5 cm and luminal diameter of 2.5 cm. Result The patient underwent open aneurysmorrhaphy with a femoral to popliteal reverse saphenous vein bypass graft. Upon direct visualization, the aneurysm was estimated to measure 8 cm length and 6 cm in diameter. The patient recovered without incident and has normal ankle brachial indices. Conclusion True isolated aneurysms in the SFA are rare, and the exact cause is not yet known. Proper diagnosis and identification are crucial to patient outcome. In our case, duplex ultrasound yielded a more accurate measurement of the true aneurysm size when compared with the angiogram. This is attributable to the angiogram measuring the flow channel of the residual lumen while not visualizing the thrombus filled sac. Endovascular stent grafts or open repair with bypass grafts (vein or prosthetic) are the accepted methods of treatment with good patient outcome. Allowed to progress untreated, these aneurysms often rupture or thrombose, which can ultimately lead to limb loss. Because of the increased incidence of aneurysmal disease elsewhere in the body, these patients should undergo additional screening.

Use of expanded polytetrafluoroethylen (ePTFE) stent graft in autogenic AV fistula with false aneurysm in lower extremity.

A 28-year-old German-Caucasian man arrived with deep vein thrombosis DVT, pain, oedema and rubor of right lower limb and drug abuse. The US Doppler imaging showed an autogenic AV fistula and false aneurysm of the right superficial femoral artery and femoral vein. The CT imaging showed additional closing of the left external iliac artery and common femoral artery, and of the distal and middle parts of the superficial femoral artery. The patient was treated within the angiography suite using a 8/25 mm (8 mm diameter/25 mm length) peripheral graft with expanded polytetrafluoroethylen ePTFE stent. After stent deployment, the dilatation was performed using 8/20 mm (8 mm diameter/20 mm length) balloons. After intervention, the digital subtraction angiography showed a good stent position with complete exclusion of false aneurysm and AV fistula. The outcome of US Doppler imaging also confirmed successful intervention.

Congenital-idiopathic superficial femoral artery aneurysm in a 7-year-old child

Superficial femoral artery aneurysm in children is distinctly uncommon, and usually results from infection, vasculitis, connective tissue disorder, or trauma. We report a 7-year-old girl who had multiple fusiform aneurysms of the right superficial femoral artery, with no evidence of related disorders. The patient successfully underwent aneurysm resection and femoral artery reconstruction with autogenous saphenous vein. Histologic examination revealed intimal thickening with fibroplasia without severe inflammatory infiltrates or cystic medial necrosis, suggesting a congenital-idiopathic arterial aneurysm. Three years after the procedure, the saphenous vein graft is fully patent and the patient is in good condition.