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.

Background: LDS is an autosomal dominant connective tissue disease. It is a rare multi-systemic disorder with serious vascular impact. Case report: We report a case of a 38-year-old male with Loeys-Dietz syndrome (LDS) suffering from major aortic complications. The disease initially manifested itself as a type A aortic dissection, successfully treated by open ascending aorta replacement. Ten days later, the patient developed an uncomplicated type B dissection. During follow up, the patient became symptomatic in both legs (rest pain) due to major true lumen compression. A thoracic endovascular aortic repair was performed with immediate improvement of the symptoms. During follow up, a computer tomography angiogram, showed a persistence false lumen perfusion and an aortic diameter increase. Multiple additional endovascular procedures and a final open thoracoabdominal aortic replacement were needed to exclude completely the false lumen. Conclusion: Open surgical repair is still the gold standard therapy for patients with connective tissue disease. However, with the nowadays progress, hybrid procedures could be a better option.