Peripheral Vascular Surgery Society

#22 ANGIOGRAPHIC EMBOLIZATION OF A TRUE ANEURYSM OF THE PROFUNDA FEMORIS ARTERY.

Preston B. Rich, MD, Seth W. Wolk, MD, and Michael J. Sarosi, MD

The Michigan Heart and Vascular Institute, Ann Arbor, MI

Introduction: True aneurysms of the profunda femoris artery (PFA) are rare, accounting for less than 0.5% of all peripheral aneurysms. High rates of associated complications have been reported, and surgical repair of all such aneurysms has been advocated. To our knowledge, this report illustrates the first case of angiographic embolization of the PFA for the purpose of excluding an unruptured PFA aneurysm.

Case Report: A 78-year-old gentleman sought medical attention because of a progressive non-tender pulsation within his proximal left thigh. Physical examination revealed a 5-cm non-tender, expansile mass in the upper medial aspect of the thigh. Color flow duplex imaging revealed a 4.8 by 4.0 cm aneurysm involving the left PFA. Biplanar angiography demonstrated generalized arterial ectasia with a large saccular aneurysm arising from the left PFA. Percutaneous angiographic coils were placed into the aneurysm and the distal PFA, resulting in aneurysm exclusion and occlusion of the distal PFA. The SFA remained patent. Pedal pulses were normal following the procedure and the patient was discharged 8 hours later. Repeat duplex imaging demonstrated a patent CFA and SFA without flow in the aneurysm or the PFA.

Discussion: Less than 35 true PFA aneurysms have been reported. The natural history of these aneurysms is unknown, but the high incidence of associated complications suggests that exclusion is prudent. Angiographic embolization may require complete occlusion of the more distal PFA. We suggest that in carefully selected patients with minimal atherosclerotic disease of the SFA, embolization of PFA aneurysms may offer a safe non-operative alternative.

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Last updated January 1,2000