A True Bilateral Superficial Femoral Artery Aneurysm: A Case Report

A 67-year-old male of Egyptian descent presented to the vascular outpatient clinic with a left lower limb pulsating mass in the mid-inner thigh region. A computed tomography angiography (CTA) revealed a 3x4cm left mid-superficial femoral artery (SFA) aneurysm and a 2x3cm aneurysm in the right mid-SFA. An open repair of the left, followed by right SFA aneurysms, was performed in a sequential matter, six weeks apart. The patient's recovery and follow-up were uneventful. Pathology revealed both specimens to be true atherosclerotic aneurysms. This is a case report of a true bilateral SFA aneurysm.

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.

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.

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.

Update on aneurysm disease: current insights and controversies: peripheral aneurysms: when to intervene - is rupture really a danger?

Peripheral artery aneurysms are rarer than abdominal aortic aneurysms (AAA), although the true prevalence is not well known. They often coexist with aortic and other peripheral artery aneurysms. In contrast to AAA, where the principal risk is that of rupture, thromboembolism is more common, contributing a bigger risk in the more common lesions. Although rupture does occur, with incidence related to anatomical site, aneurysm diameter cannot be used to guide management with the same confidence as in AAA. In addition, the rarity of these lesions results in a paucity of evidence with which to guide intervention. Consequently they are difficult lesions to manage, and numerous aneurysm and patient factors must be considered to provide treatment individualised for each case. We discuss popliteal, femoral, carotid, subclavian, upper limb, visceral and false aneurysms, focussing on the risk of rupture and thromboembolism, and current thresholds for intervention, based on the available published literature.