Isolated atherosclerotic aneurysm of the superficial femoral artery - case report
(Portuguese PDF version)

Cristiano do Carmo Galindo1, Carlos Augusto Lima2, JosÚ ╔dson Cardoso3, Geraldo Galindo Filho1, VinÝcius Scalco Costa1, Fernando Marcondes Penha1

1. Medicine student.
2. MD, specialist in Angiology and Vascular Surgery.
3. PhD, specialist in Angiology and Vascular Surgery.

* Division of Vascular Surgery of Hospital Marieta Konder Bornhausen, Itajaí, State of Santa Catarina, Brazil.

Correspondence:
Cristiano do Carmo Galindo
Rua Timbó, 301/605
CEP 89012-180 - Blumenau - SC
Tel.: +55 47 340.2455 / 9101-6990
E-mail: crigalindo@al.furb.br


ABSTRACT

Isolated atherosclerotic aneurysms of the superficial femoral artery are rare. Due to their infrequency, we report an original case of superficial femoral aneurysm without concomitant aneurysms. The literature review emphasizes the great latency of the disease and the high incidence of complications at presentation, risk factors, diagnostic difficulty due to lack of information about its natural history, surgical indications and the favorable prognosis after surgical treatment, with good limb salvage rates.

Key-words: aneurysm, femoral artery, surgery.
Palavras-chave: aneurisma, artéria femoral, cirurgia.

J Vasc Br 2003;2(2):145-7


According to the Subcommittee on Reporting Standards for Arterial Aneurysms, 1991,1 aneurysms are defined as a permanent and located dilation of an artery. It has at least 50% of dilation compared with the expected normal diameter for the artery in question. The expected diameter depends on some factors such as patient's age, sex, physical condition and the method used. Femoral aneurysms are classified as peripheral aneurysms. They are much less frequent than aortic aneurysms.2,3

The isolated superficial femoral aneurysm has a very low incidence.2 It can be symptomatic or asymptomatic and diagnosed by palpation of a pulsatile tumor in the inguinal region. This kind of aneurysm has favorable prognosis after surgical treatment.

An original case of isolated aneurysm of the superficial femoral artery is reported, and the literature reviewed.

CASE REPORT


A 67-year-old woman has presented with a painless and pulsatile mass in the right inguinal region for six months, associated with local itching. She has no alterations of temperature, color, trophic or sensitivity disorders or edema in the right lower limb. She has no history of cigarette smoking, sedentary lifestyle, hypertension, hypercholesterolemia or diabetes. On physical examination, she presented a palpable, pulsatile and non-visible mass in the upper third of the right thigh. This mass is painful to deep palpation and does not show evidence of rupture and distal ischemia. The extremities are warm and symmetric with normal distal pulses. She presents a discrete murmur in the right inguinal region (+ / 4+).

Three months ago, the patient was submitted to ultrasonography, which detected atheromatosis of the right lower limb arteries, associated with a bulky aneurysm in the medial third of the right superficial femoral artery (6.9 x 2.8 x 2.6 cm) without concomitant aneurysms in other arteries. The patient underwent a surgical excision of the right superficial femoral artery (Figure 1) and Dacron 6mm synthetic graft replacement (Figure 2). The pathoanatomical exam showed the atherosclerotic etiology of the aneurysm.

After surgery, the patient showed no evidence of ischemic or embolic complications during a 12-month follow-up period. Ultrasonographic exams were performed at three, six and twelve months.

click hereFigure 1 - Anatomic location of the superficial femoral aneurysm measuring 6.9 x 2.8 x 2.6 cm in the perioperative period.

click hereFigure 2 - Restoration of circulation with the Dacron 6mm graft used in our patient.

DISCUSSION

Isolated atherosclerotic aneurysms of the superficial femoral artery, as reported herein, are rare. According to the literature this rarity occurs because the superficial femoral artery is relatively more protected against the development of aneurysms than the common femoral and popliteal arteries. This occurs due to their excellent muscular support and absence of bending stress.2

Most isolated aneurysms of the superficial femoral artery have traumatic and mycotic origin .4 In the absence of such clear etiologic factors, most of aneurysms have been considered "atherosclerotic", even when there is little or no evidence of atherosclerosis in other vessels.2

The natural history of superficial femoral aneurysm is not so clear because few cases have been reported up to now. In a literature review performed in 1995, only 21 aneurysms had been reported in 17 patients.5 Concomitant aneurysms were present in 69% of the cases and the association with abdominal aortic aneurysm was the most frequently observed one (40% of the cases). The average age was 77 years old (61-93 years old), with prevalence of males (75%).2

Aneurysms of the superficial femoral artery usually manifest as a pulsatile mass in the medial region of the thigh. It may be painful, but asymptomatic, thus making the diagnosis an occasional finding. When the superficial femoral artery is relatively deep into the thigh, the aneurysm usually increases significantly before it is diagnosed. This hinders the recognition of asymptomatic injuries.4 According to Rigdon & Monajjen, 65% of the aneurysms appear through complications such as rupture (35%), thrombosis (18%) and distal embolic events (12%).2

The diagnosis can be confirmed with ultrasonography, computed tomography or magnetic resonance. Arteriography is reserved for the surgical planning.

Surgical treatment is indicated for all symptomatic aneurysms. Asymptomatic aneurysms over 2.5 cm in diameter are treated with surgical resection as well.4 The ultrasonographic finding of thrombi covering the internal wall of the aneurysm is a sign of surgical indication. Surgical treatment is indicated regardless of their size because these thrombi are responsible for the main complications of these aneurysms. The treatment consists of the resection of the aneurysm rather than ligation of the proximal and distal artery and bypass of the ligated segment.4 The limb salvage rate was 94% and there were no perioperative deaths.3 Although the superficial femoral aneurysms are technically easy to resect, with the restoration of circulation, the long-term reconstruction results are not as efficient as they are for the common femoral aneurysm. This happens because they are usually associated with multiple occlusive and stenotic injuries. These lesions compromise the functioning of the grafts in the medium and long term.

REFERENCES

1. Johnson KW, Rutherford RG, Tilson MD, Shah DM, Hollier L, Stanley JC. Suggested standards for reporting on arterial aneurysms. J Vasc Surg 1991;13:452-58.

2. Rigdon EE, Monajjem N. Aneurysms of the superficial femoral artery: a report of two cases and review of the literature. J Vasc Surg 1992;16:790-93.

3. Vasquez G, Zamboni P, Buccoliero F, Ortolani M, Berta R, Liboni A. Isolated true atherosclerotic aneurysms of the superficial femoral artery. J Cardiovasc Surg 1993;34:511-12.

4. Graham LM. Femoral and popliteal aneurysms. In: Rutherford RG, editor. Vascular Surgery. Philadelphia: WB Saunders; 2000. p. 1345-1356.

5. Brito CJ. Aneurismas periféricos. In: Maffei FHA, editor. Doenças Vasculares Periféricas. Rio de Janeiro: MEDSI; 2002. p. 1149-1171.

 


J Vasc Br - Official Publication of the Brazilian Society of Angiology and Vascular Surgery