Giant Spontaneous Femoral Artery Pseudoaneurysm Treated with Covered Stents: Report of a rare presentation and review of literature

Spontaneous bilateral superficial femoral artery pseudoaneurysms and a unilateral posterior tibial artery aneurysm in an immunocompromised patient

Key Clinical Message

The presence of multiple pseudoaneurysms in a patient should prompt investigations for the underlying etiologies including autoimmune and immunosuppressive disease processes. Treatment options include open repair and endovascular stenting.

Abstract

Pseudoaneurysms (also known as false aneurysms) are atypical dilatations or outpouchings from a vessel which are not always contained by the three layers of a normal vessel wall, namely the intima, media, and adventitia. These are distinct from a true aneurysm which has a wall comprising all three layers. The underlying etiology for both true aneurysms and pseudoaneurysm can vary. We present the rare case of bilateral superficial femoral artery pseudoaneurysms, of unknown etiology and a concurrent posterior tibial artery saccular aneurysm in a patient with Human Immunodeficiency Virus (HIV) infection and multiple comorbidities. This was managed using a combination of endovascular covered stent grafts and open surgical repair technique. The patient is doing well on follow-up a year later with no post-operative infections. A literature review of the existing reports of superficial femoral artery pseudoaneurysms and posterior tibial artery aneurysms and their management is also reported.

Successful Surgical Management of Post-traumatic Superficial Femoral Artery Pseudoaneurysm With Delayed Presentation

Pseudoaneurysms of the superficial femoral artery are uncommon and typically iatrogenic. The majority of publications on this topic that have been published in English literature are case reports. It is unclear how often arterial pseudoaneurysms (APAs) caused by limb trauma occur, and their treatment is not standardised. A review of the literature usually follows the presentation of a case report, but no recent update with reliable data has been published. In this case study, a 24-year-old patient who had a piece of iron lodged in the middle third of his thigh and a pulsatile mass that revealed a pseudoaneurysm of the superficial femoral artery is described. The patient underwent an emergency operation without employing a venous graft. We directly sutured the arterial lesion, with positive outcomes.

Superficial femoral artery-anterior tibial artery bypass with great saphenous vein grafting via the lateral femoropopliteal route for infection after Viabahn placement

We report a case involving an elderly man who successfully underwent superficial femoral artery-anterior tibial artery bypass via the lateral femoropopliteal route following development of a stent infection after placement of a small-diameter covered stent for a ruptured superficial femoral artery pseudoaneurysm. This report suggests that appropriate treatment strategies for device infection subsequent to device removal are paramount for the prevention of reinfection and preservation of the affected extremity.

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.

Clinical evaluation of covered stents in the treatment of superficial femoral artery pseudoaneurysm in drug abusers

The present study aimed to investigate the technical feasibility and initial clinical outcomes of a covered stent for the endovascular treatment of superficial femoral artery (SFA) pseudoaneurysm in drug abusers. A total of 29 drug abuse patients with SFA pseudoaneurysm, as confirmed by color Doppler sonography, were enrolled to the present study between January 2012 and May 2014. All patients were treated percutaneously by implantation of a covered stent. Physical examination and lower extremity computed tomography angiography were performed at 1 and 9 months postoperation. Furthermore, the ankle-brachial index (ABI) of all patients was measured. The results indicated that placement of the covered stent was technically successful in all 29 patients. All of the ruptured pseudoaneurysms were successfully sealed with no cases of intraprocedural mortality. In addition, all patients' conditions improved rapidly; active hemorrhage subsidence and vascular bruit disappearance were immediately detected following implantation of the covered stent. During the follow-up period, pain was markedly alleviated and pulsatile mass was decreased as time increased. No complaints or complications were documented. A total of 9 months postoperation, pain and pulsatile mass were not detected. The patency rate of the stent was 100%, and no migration, occlusion or infection was detected. In addition, the ABI was significantly improved, from 0.52±0.09 to 0.97±0.37 (P<0.01). In conclusion, the placement of a covered stent may be considered a promising approach to provide an effective, safe and minimally invasive option for the treatment of SFA pseudoaneurysm in drug abusers.