Ruptured aneurysm of the proximal third of the superficial femoral artery: Case report

An 83-year-old man affected by a polyaneurysmatic disease who previously underwent elective repair of an abdominal aortic aneurysm 20 years ago, presented to the emergency department with a huge, growing and painful mass in his left thigh. Urgent computed tomography (CT) angiography revealed a 13x11 cm partially thrombosed aneurysm of the proximal third of the superficial femoral artery with signs of edema and inflammation of the contiguous tissues. Omolaterally, a 4.7 cm aneurysm of the common femoral artery and another 3,7cm completely thrombosed aneurysm of the popliteal artery were detected. Because of the chronic obliteration of the popliteal aneurysm and of the distal arteries, revascularization was not necessary. We performed an excision of the aneurysm and an external iliac-deep femoral artery PTFE interposition graft. At completion of the surgical procedure, the patient had a warm perfused limb. The graft is pervious after 12 months follow-up. Degenerative aneurysms of the superficial femoral artery are rare. Only 62 cases have been reported in literature, and only 7 (11.2%) are located in the proximal third of the blood vessel. Such anatomical location is correlated to an high amputation rate. This is probably associated to procedural technical difficulties such as the involvement of the profunda or diameter incongruity between the vessel and the vascular graft, as we report. Aneurismectomy and revascularization of the lower limb is the first-choice treatment for this type of lesions.