Femoral Aneurysm Repair

Excerpt

A vessel is considered to be aneurysmal when it enlarges to about one and a half to two times the size of the normal vessel. True femoral artery aneurysms are rare and include dilation of all the layers of the vessel wall. In contrast, femoral artery pseudoaneurysms are more commonly encountered in clinical practice, often after iatrogenic trauma from diagnostic or interventional arterial procedures. Pseudoaneurysms, also known as false aneurysms, do not involve all layers of the vessel wall. Patients with aortic or other peripheral aneurysms can have synchronous or metachronous femoral artery aneurysms. As with any peripheral or a visceral aneurysm, the main risks associated with femoral artery aneurysms include thrombosis/occlusion, distal embolization, and rupture. This clinical entity is rare; therefore, the natural history is not well defined.

Femoral artery aneurysms are more commonly seen in individuals who are older than 70 years of age and male. Femoral artery aneurysms can be bilateral in up to 70% of cases. Up to 25% of patients with femoral artery aneurysms can have an abdominal aortic or iliac artery aneurysm. Risk factors for femoral artery aneurysms include smoking, arteriosclerosis, high blood pressure, and systemic connective tissue disorders.

In asymptomatic patients, these aneurysms may be detected by patients or on physical examination as a groin bulge or mass. Because of this presentation, it can be easily confused with a hernia. However, on physical examination, strong pulsation of this mass should raise the suspicion for a femoral artery aneurysm. A complete lower extremity vascular examination should be performed to ensure that there is no sign of distal embolization. In addition, the extremity should be inspected for swelling as large aneurysms can compress venous return from the lower extremity and cause lower extremity venous congestion/edema or even deep venous thrombosis. Patients may experience pain from pressure on surrounding structures or nerves. Patients should be asked about a preceding history of trauma to the groin. Physical examination should include a search for aneurysms at other body sites. As any arterial aneurysm can be mycotic, patients should be asked about symptoms of systemic infection and examined for signs of systemic infection (such as endocarditis).

Work up for a femoral artery aneurysm can include an ultrasound, computed tomography angiography, or magnetic resonance angiography. Depending on the acuity of the situation, CT angiography is often the first investigation employed as it provides excellent anatomic information for possible intervention.