An isolated true aneurysm of the deep femoral artery: an uncommon but dangerous pathology

L. Salomon Du Mont-Besch, S. Engelberger, T. Holzer, C. Dubuis, F. Saucy, J.-M. Corpataux, S. Déglise

Objective

Most of the aneurysms located at the groin are false aneurysm after arterial puncture. True aneurysms of the deep femoral artery (DFA), by representing 5% of all femoral aneurysms are uncommon, carrying a high risk of rupture. They are often associated to aneurysms elsewhere.

Methods

We report the case of a 83-year-old patient with a painless pulsatile groin mass due to an aneurysm of the deep femoral artery.

Results

This patient without any cardiovascular risk factors didn’t present any aneurysms at other localization. The etiology remained unclear because no recent history of local traumatism or puncture was found. Moreover, there was neither an episode of fever nor any signs of infection. An angio-CT scan was performed, revealing a true isolated DFA aneurysm with a diameter of 90mm, beginning 1 cm after its origin. There were no signs of rupture or distal emboli. Due to unsuitable anatomy for an endovascular approach, the patient was operated through open surgery, with exclusion of the aneurysm and interposition of a 8-mm Dacron graft to preserve DFA flow.

Conclusion

Due to their localization, the diagnosis and the management can be difficult. Options are surgical exclusion or endovascular approach in the absence of symptoms or as a bridging therapy. If possible, blood flow to the distal deep femoral artery should be maintained, the decision depending also on the patency of the superficial femoral artery. In case of large size, DFA should be treated without any delay.