Endovascular Management of a True Aneurysm of the Profunda Femoris Artery

Abstract

Isolated true aneurysms of the profunda femoris artery account for less than 0.5% of all peripheral aneurysms. Because of the high rate of associated complications, open surgical repair has been advocated for all such aneurysms. To general knowledge, this report documents the first case of endovascular management of an isolated true aneurysm of the profunda femoris artery. A 78-year-old man presented with an enlarging pulsation of the proximal left thigh. Physical examination revealed a 5 cm, nontender, expansile mass in the upper medial aspect of the left thigh. Color flow duplex imaging showed a 4.8 x 4.0 cm aneurysm involving the proximal left profunda femoris artery. Biplanar angiography demonstrated generalized arterial ectasia with a 2.2 x 4.4 cm discrete, saccular aneurysm arising from the proximal left profunda femoris artery. Because of the patient's medical comorbidities, an endovascular approach to the management of the aneurysm was elected. Percutaneous angiographic coils were placed in the aneurysm as well as in the profunda femoris artery beyond the aneurysm resulting in aneurysmal thrombosis. The distal profunda femoris artery and superficial femoral artery remained patent. Pedal pulses were normal following the procedure and the patient was discharged 8 hours later in good condition. Subsequent duplex imaging performed 1 month following the intervention demonstrated a patent common femoral artery and superficial femoral artery without flow in the aneurysm. A review of the literature revealed 35 reported cases of isolated true aneurysms of the profunda femoris artery. The natural history of these aneurysms is not well defined; however, exclusion is prudent in most cases because of a high rate of associated complications with conservative management. Endovascular management with coil embolization may necessitate occlusion of the distal profunda femoris artery. Results of this case report suggests that coil embolization of true aneurysms of the profunda femoris artery may offer a safe and effective alternative to open surgical repair in carefully selected patients with minimal occlusive disease.