Vascular surgical management of profunda femoris artery aneurysms: A single center experience

Abstract

ObjectiveProfunda femoris artery aneurysms (PFAAs), which comprise true profunda femoris artery aneurysms (TPFAAs) and profunda femoris artery pseudoaneuryms (PFA PSAs), are rare but clinically significant diseases of the peripheral arterial vasculature. Our aim is to describe our institution’s 15-year experience with PFAAs (TPFAAs and PFA PSAs) to provide insight into patient characteristics, diagnostic imaging modalities, and surgical interventions that contribute to clinically important outcomes in patients with PFAAs.MethodsWe conducted a retrospective study at our institution using our radiology database.ResultsWe identified six patients with PFA PSAs and four patients with TPFAAs. The clinical presentation of PFA PSAs included a triad of thigh pain, bleeding, and unexplained anemia. There was variety in the aetiologies of PFA PSAs, arising from catheterizations, upper thigh fractures, anastomotic complications, or unknown causes. Most patients with PFA PSAs had hypertension and coronary artery disease, and half of our cohort had peripheral vascular disease. All patients were imaged with duplex ultrasonography (DUS) or computed tomography (CT), the latter being more accurate. All patients with PFA PSAs underwent endovascular treatment, including glue, thrombin, or coil embolization as well as stent-graft insertions. All TPFAAs presented to our center were small and incidentally discovered, explaining the conservative management of our TPFAAs. Two of the four TPFAAs were idiopathic in nature, while one was attributed to post-stenotic dilatation, and another was found in a patient with Ehlers Danlos Syndrome. There was an association between TPFAAs and multiple synchronous or asynchronous aneurysms.ConclusionPseudoaneurysms of the PFA are mostly iatrogenic in nature and can present with the triad of thigh swelling, bleeding, and unexplained anemia. If the clinical picture is suggestive of a PFA PSA but DUS does not detect a pseudoaneurysm, CT may be added as a more accurate imaging modality. Endovascular embolization is used in smaller pseudoaneurysms and in poor surgical candidates. Multiple glue, coil, or thrombin injections may be required to fully thrombose the pseudoaneurysm sac. True aneurysms of the PFA are associated with synchronous/asynchronous aneurysms and small TPFAAs should be carefully monitored, as there is a risk of enlargement and rupture.