Endovascular Repair of a Large Profunda Femoris Artery Pseudoaneurysm

Profunda femoris artery aneurysms and pseudoaneurysms are a rare cause of peripheral arterial aneurysms but their risk of rupture is quite high. We have presented a case of a left lower leg pseudoaneurysm. We have shown that endovascular repair with angioplasty and stenting is a suitable treatment method for such a pseudoaneurysm. Due to the limited data on this disease, we suggest multi-institute collaboration to identify and standardize management for the treatment. 1. Introduction Profunda femoris artery aneurysms (PFAAs) are a rare cause of peripheral arterial aneurysms; however, the risk of rupture associated with such a finding is quite high. PFAAs are mostly asymptomatic and they usually present as an incidental finding. As for symptomatic patients, a swelling in the groin region is the most common presentation [1–3]. True aneurysms of the profunda femoris artery (PFA) are relatively rare (1–2.6%) and are idiopathic in nature without any suggestive cause. On the other hand, pseudoaneurysms of the PFA are more common and are generally secondary to, but are not limited to, orthopedic procedures, fractures, and penetrating or blunt trauma [2, 4]. We present a case of a PFA pseudoaneurysm in a patient with an orthopedic history. 2. Case Report This is a case of a 38-year-old male who underwent intermedullary nailing of the left hip for avascular necrosis in September 2012. In March 2013, the patient presented with complaints of increasing edema of his left lower extremity associated with a palpable pulsatile mass in the anterolateral aspect of his thigh. At that point, the patient denied calf claudication on ambulation, nocturnal rest pain, or any other symptoms of the lower extremities. On exam, a palpable pulsatile mass in the anterolateral aspect of his thigh was noticed. He had a palpable thrill over it. Nevertheless, all lower extremity pulses were palpable. A computed tomography (CT) angiogram (Figure 1) with 3-dimensional reconstructions (Figure 2) was obtained. The imaging revealed a left PFA pseudoaneurysm measuring 5？cm in AP diameter. The neck of the pseudoaneurysm was located 6？cm distal to the femoral bifurcation. In April 2013, the patient underwent exclusion of the left PFA pseudoaneurysm via covered stent placement. Figure 1: CT angiogram showing the left profunda femoris artery pseudoaneurysm. Figure 2: 3D reconstruction of left profunda femoris artery pseudoaneurysm. (a) Posterior-superior view, (b) left anterolateral view. 3. Procedure Right common femoral artery (CFA) access was obtained with a micropuncture needle. A crossover