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

Abstract

Objectives: Because there is a paucity of data about management and outcome of true profunda femoris artery aneurysms (PFAAs), we reviewed our 21-year experience with surgical repair of PFAAs.

Methods: Clinical data from the 15 patients who underwent repair between 1985 and 2006 were retrospectively reviewed.

Results: Fifteen men had 17 PFAAs (mean diameter, of 3.4 cm). Three had an acute presentation with rupture (n = 2) or acute limb ischemia (n = 1), one had local tenderness, and 11 were asymptomatic. Sizes of the ruptured PFAAs were 1.5 and 7.5 cm. Eleven patients (73%) had synchronous aneurysms, most frequently in the popliteal artery (n = 7). Three of the asymptomatic patients required an emergency operation because of acute lower extremity ischemia caused by thrombosis of a synchronous popliteal aneurysm (n = 2) or for a ruptured iliac aneurysm (n = 1). Aneurysmectomy with graft interposition between the common femoral and PFA was used in 15 repairs. Ligation alone was used for one aneurysm, and another was treated by partial aneurysmectomy with primary repair. There were no deaths, graft thrombosis, or limb loss at 30 days. At a mean follow-up of 28 months (range, 3 to 108 months), one patient required above knee amputation 2 years after aneurysm ligation, and another patient presented with a recurrent aneurysm. Long-term graft patency was 100%.

Conclusions: PFAAs are rare but often occur with synchronous aneurysms. One-third of patients presented with complications of limb ischemia or rupture caused by their PFAA or synchronous aneurysms. Good-risk patients with a PFAA >2 cm should undergo elective repair. Aneurysmectomy with femoral interposition graft is a durable repair.