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.Keywords: superficial femoral artery; ruptured aneurysm. ResumoOs aneurismas de artéria femoral são raros e ocorrem geralmente em pacientes idosos. Estão frequentemente associados a outros aneurismas, tanto periféricos como de aorta abdominal. O presente relato refere-se a um jovem portador de aneurisma de artéria femoral superficial (AFS), cuja apresentação clínica foi a ruptura. O paciente foi submetido ao tratamento convencional, com ressecção do aneurisma e interposição de veia safena magna ipsilateral. A revisão da literatura corrobora a raridade do caso.Palavras-chave: artéria femoral superficial; aneurisma roto. C A S E R E P O R T Superficial femoral artery aneurysmThese characteristics suggested a ruptured aneurysm of the superficial femoral artery.Arteriography showed that the abdominal and iliac aortas were patent, with no significant obstructions, and that the mid segment of the right superficial femoral artery was dilated. The distal segment showed signs of compression by the adjacent mass and the distal superficial femoral and popliteal arteries had flow, primarily originating in collateral branches (Figures 2, 3 and 4).The patient underwent exploratory surgery of the left lower limb. There was a large-volume hematoma related to the ruptured aneurysm of the left superficial femoral artery ( Figure 5).The aneurysm was resected and the vascular segment reconstructed by reversed interposition of a segment of the ipsilateral saphenous vein (Figure 6). The surgical technique employed was continuous sutures at the arterial anastomoses using 6.0 polypropylene thread. The muscle planes were drawn together using continuous 3.0 nylon thread sutures and skin was sutured with separated 4.0 nylon thread sutures.During the postoperative period, the patient suffered hematoma of the surgical wound and an infection, requiring a second intervention for drainage and surgical debridement, which increased the length of hospital stay and the morbidity related to the procedure. The patient was discharged from hospital 19 days after the first surgery.The patient underwent transesophageal echocardiogram during the postoperative period, with normal results. Fragments of tissue removed during the first operation were sent for microscopic examination and bacteriological tests; but no germ growth was detected. The patient was subjected to rheumatologic tests and the results were negative.

CHIVA (Cure Conservatrice et Hemodynamique de l’Insufficience Veineuse en Ambulatoire) is a type of operation for varicose veins that avoids destroying the saphenous vein and collaterals. We report a case of CHIVA treatment of two saphenous veins to spare these veins. The patient previously had a normal great saphenous vein stripped in error in a wrong-site surgery, while two saphenous veins that did have reflux were not operated. The patient was symptomatic and we performed a CHIVA operation on the left great and right small saphenous veins. The postoperative period was uneventful and both aesthetic and clinical results were satisfactory. This case illustrates that saphenous-sparing procedures can play an important role in treatment of chronic venous insufficiency. Additionally, most safe surgery protocols do not adequately cover varicose veins operations. Routine use of duplex scanning by the surgical team could prevent problems related to the operation site.

The use of focused ultrasound and highintensity focused ultrasound (HIFU) is common in physical therapy and medical procedures. The ultrasound produces heat and can be used to treat several diseases. We report a case of a 49-year-old male that had a knee injury after mild trauma. The patient started physical therapy sessions to treat the injury. Ipsilateral calf claudication started a few hours after the focused ultrasound was used to heat the popliteal area progressing to symptoms of acute arterial occlusion in two weeks. We started anticoagulation and confirmed popliteal thrombosis with duplex scan and computed tomography. The 5 years follow up showed good clinical recovery and recanalization of the artery. This case reminds us that the focused ultrasound should not be considered harmless and life-threatening complications may occur. The inadvertent heating of neighboring structures and recanalization of the heated vessel may happen.

Nerve damage is the most important reason for malpractice claims after venous procedures. The incidence of nerve damage varies according to the technique and 4% to 23% present symptoms of nerve damage after varicose vein operations. The knowledge about nerve physiology and anatomy, proper preoperative ultrasound planning, clear communication, safe operation protocols, and good clinical records are pivotal to avoid such complications. Even so, there is no guarantee that a lesion will not occur. Nerve damage can happen with the best surgeons. The purpose of this paper is to review nerve physiology and its anatomy in relation to saphenous veins, to relate the incidence of nerve injury to each surgical technique and to outline strategies to prevent and treat this complication.