Rupture of a true profunda femoris artery aneurysm

Abstract

Peripheral artery aneurysms a r e uncommon and almost always occur in the lower limb. T h e popliteal artery accounts for 55 per cent and the common femoral artery for 42 per cent of aneurysms of the leg'. Aneurysms of t h e profunda femoris artery ( P F A ) a r e estimated t o represent 0.5 per cent of all peripheral artery aneurysms b u t a r e rarely considered as a cause of thigh swelling and are often missed, with subsequent limb loss. A ruptured PFA aneurysm in which the diagnosis had been missed, with potentially catastrophic consequences, is reported. Case reportA 77-year-old man suddenly developed a painful swelling in the left thigh while on holiday abroad. He continued his 2-week vacation and on return to the U K was referred by his general practitioner to hospital where an 8-cm abdominal aortic aneurysm was found on ultrasonography. The patient was concerned that he was scheduled for abdominal operation only to repair the aortic aneurysm and requested a second opinion. The man had had no previous cardiac or cerebrovascular disease and no symptoms of intermittent claudication. He was anaemic, with left upper thigh swelling and bruising over the medial aspect. Bilateral femoral and popliteal artery aneurysms were identified with all peripheral pulses palpable. Routine laboratory investigations revealed a hypochromic microcytic anaemia (haemoglobin level 8.8 g/dl; all other indices were normal). Colour Doppler ultrasonography demonstrated a large aneurysm arising from a connection with the left PFA. Computed tomography of the pelvis and upper thighs confirmed aneurysms of the abdominal aorta and both common iliac arteries. In the upper thigh there was a 20-cm diameter heterogeneous soft tissue mass continuous with the profunda femoris vessel with a clear soft tissue plane between it and the superficial femoral artery on all sections ( Figure I ). This aneurysm was confirmed by arteriography ( Figure 2 ) .Laparotomy revealed a 7-cm aneurysm of the aorta and right common iliac artery, with a 3-cm aneurysm of the left internal iliac artery. A massive aneurysm in the left thigh contained 2 litres of old thrombus and blood clot, and communicated freely with a ruptured aneurysm of the left PFA 8 cm from its origin. After cross-clamping, the aortic and iliac aneurysms were opened and the lumbar arteries under-run with polyglactin sutures. The left external and internal iliac arteries and right external iliac arteries were oversewn with polypropylene, and an 8-mm Dacron ( D u Pont, Stevenage, U K ) tube graft sutured into the origin of the right internal iliac artery. A 22 x 11 mm bifurcation graft was anastomosed end to end to the infrarenal aorta. Both limbs were directed retroperitoneally and anastomosed end to end to the common femoral bifurcation, and the right internal iliac graft was sutured end to side to the right limb of the bifurcation graft. The aneurysm in the left thigh was opened and the feeding PFA ligated proximally and sutured distally. After surgery the patient developed a lymphocele of the ri...

Atherosclerotic aneurysms of the profunda femoris arteries—Case report and literature review

“…However, if the superficial femoral artery is patent, ligation does not cause ischemia of the lower extremity [6][7][8]10,15,17]. Therefore, in such cases, reconstruction of the profunda femoris artery may not be needed.…”

“…In cases of profunda femoris aneurysms, 33%-45% had other aneurysms in the aortoiliac, with peripheral lesions [6,7]. Profunda femoris aneurysms usually present with pulsatile masses in the groin and accompanying rupture [6,[8][9][10][11][12][13][14][15][16][17], and ischemia due to thrombosis and embolization [5,[18][19][20][21]. Lozano et al [15] reported that 13 (35.1%) of 37 cases presented with rupture, and Yahel and Witz [6] reported that 40% were ruptured.…”

Profunda femoris artery aneurysms: Association with aneurysmal disease and limb ischemia

“…6,[9][10][11][12] The incidence of PFAA rupture in our series was 13%. This is similar to the 10% to 14% rates quoted for common femoral artery aneurysms.…”

Atherosclerotic aneurysms of the profunda femoris arteries—Case report and literature review

“…In cases of profunda femoris aneurysms, 33%-45% had other aneurysms in the aortoiliac, with peripheral lesions [6,7]. Profunda femoris aneurysms usually present with pulsatile masses in the groin and accompanying rupture [6,[8][9][10][11][12][13][14][15][16][17], and ischemia due to thrombosis and embolization [5,[18][19][20][21]. Lozano et al [15] reported that 13 (35.1%) of 37 cases presented with rupture, and Yahel and Witz [6] reported that 40% were ruptured.…”

“…Ligation only, without reconstruction of the profunda femoris artery, sometimes leads to severe leg ischemia and possible amputation of a lower extremity [26]. However, if the superficial femoral artery is patent, ligation does not cause ischemia of the lower extremity [6][7][8]10,15,17]. Therefore, in such cases, reconstruction of the profunda femoris artery may not be needed.…”