[MP-2] Repair of a Ruptured Isolated Common Femoral Artery Aneurysm
Isolated true aneurysms of the common femoral artery are exceedingly rare and their natural history is not well understood. Acute complications such as rupture can be limb-threatening. A case is described of a 75-year-old man with a ruptured common femoral artery (CFA) aneurysm.
He presented with left iliac fossa pain on a background of heavy smoking and untreated hypertension. On examination of the left lower limb there was a large, tender, pulsatile infrainguinal mass. There was a weak popliteal pulse but no pedal pulses. There were signs of venous congestion and reduced sensation in the distribution of the lateral cutaneous femoral nerve. He was haemodynamically stable. A CT angiogram revealed an isolated 65x63mm fusiform aneurysm of the left CFA containing eccentric thrombus and an absence of contrast distal to the SFA.
The decision for urgent repair was based on a number of factors; the high risk of rupture, symptoms consistent with extrinsic compression of surrounding structures and imaging suggestive of impending thrombosis and ischaemia. The retroperitoneum was entered through a Rutherford Morrison incision and acute haematoma was unexpectedly seen tracking along the left psoas muscle. After clamping the external iliac artery (EIA) and through a groin incision the superficial femoral artery and profunda femoris artery, the aneurysm sac was opened to reveal a significant volume of mural thrombus and a large defect in the posterolateral wall. The thrombus was evacuated and an 8mm reinforced interposition Gore Propaten Vascular Graft (Flagstaff, AZ, USA) was sutured from the distal EIA to the distal CFA. Histopathology revealed marked atherosclerotic plaque with dystrophic microcalcification.
Post-operatively the left lower limb was well perfused with a strong posterior tibial pulse and the patient made a complete recovery.
He presented with left iliac fossa pain on a background of heavy smoking and untreated hypertension. On examination of the left lower limb there was a large, tender, pulsatile infrainguinal mass. There was a weak popliteal pulse but no pedal pulses. There were signs of venous congestion and reduced sensation in the distribution of the lateral cutaneous femoral nerve. He was haemodynamically stable. A CT angiogram revealed an isolated 65x63mm fusiform aneurysm of the left CFA containing eccentric thrombus and an absence of contrast distal to the SFA.
The decision for urgent repair was based on a number of factors; the high risk of rupture, symptoms consistent with extrinsic compression of surrounding structures and imaging suggestive of impending thrombosis and ischaemia. The retroperitoneum was entered through a Rutherford Morrison incision and acute haematoma was unexpectedly seen tracking along the left psoas muscle. After clamping the external iliac artery (EIA) and through a groin incision the superficial femoral artery and profunda femoris artery, the aneurysm sac was opened to reveal a significant volume of mural thrombus and a large defect in the posterolateral wall. The thrombus was evacuated and an 8mm reinforced interposition Gore Propaten Vascular Graft (Flagstaff, AZ, USA) was sutured from the distal EIA to the distal CFA. Histopathology revealed marked atherosclerotic plaque with dystrophic microcalcification.
Post-operatively the left lower limb was well perfused with a strong posterior tibial pulse and the patient made a complete recovery.