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PubMed2005

True and false aneurysms of the femoral artery.

True aneurysms of the femoral artery are uncommon. They are most often identified in elderly males and are frequently associated with aneurysms at other locations. Femoral artery aneurysms that are symptomatic or larger than 2.5 cm should be repaired in order to prevent limb-threatening complications, such as rupture, thrombosis, or embolization. Open repair is the standard method of treatment and should be preceded by evaluation for coexisting aortoiliac or popliteal aneurysms, assessment of superficial femoral artery patency, and determination of the point of origin of the deep femoral artery relative to the aneurysm sac. Femoral artery pseudoaneurysms are most often seen in the setting of previous femoral artery catheterization but may also be associated with trauma, anastomotic leakage, or infection. The majority of femoral pseudoaneurysms less than 3 cm in diameter will spontaneously thrombose and may be observed with serial duplex ultrasound exams in asymptomatic patients. Symptomatic pseudoaneurysms, pseudoaneurysms with a diameter greater than 3 cm, and those found in patients who are anticoagulated should usually be treated. Ultrasound-guided thrombin injection is our preferred method for treating femoral pseudoaneurysm because of its low risk, high success rate, and efficacy in the setting of anticoagulation. Ultrasound-guided compression is an alternative method that may be considered when thrombin products are contraindicated. Open pseudoaneurysm repair should be undertaken in the setting of infection, rapid expansion, or if less-invasive methods are not technically feasible.

Aneurysm↗
PubMedDate not supplied

Peroneal artery approach for angioplasty of the superficial femoral artery: a case report.

The authors report the implantation of a Palmaz stent in the superficial femoral artery using an approach not previously described, the peroneal artery. A 64-year-old man was admitted with extensive necrosis of the right foot. Physical examination showed a normal right femoral pulse but absence of popliteal and tibial pulses. Arteriography showed a superficial femoral artery with critical stenoses but a normal profunda artery. A classic below-knee amputation was performed. During the procedure, the muscular blood flow was considered insufficient, by clinical experience, to achieve limb healing at this level, and so the surgeon chose to perform an angioplasty of the superficial femoral artery lesion, utilizing an access through the leg arteries. After introducing the guidewire through the peroneal artery, the surgeon successfully dilated the lesion and implanted a Palmaz stent. Afterward, the popliteal pulse became palpable in physical examination and improved the skin and muscular aspect in this level. The surgery was finished with a closed stump. The surgery healed satisfactorily, without any complications, and the patient had a satisfactory follow-up, with ambulatory rehabilitation, and recovery of walking capacity with a leg prosthesis. The peroneal approach gave satisfactory results and should be considered in clinical situations like this.

Amputation, Surgical↗
PubMed1975

Acute common femoral arterial trauma.

1) Acute common femoral arterial injuries remain relatively uncommon in both military and civilian practice. 2) The recent experience in Vietnam has provided the most complete statistics regarding this type of injury. Among 1,000 acute major arterial injuries, the incidence of common femoral arterial trauma was approximately 5%. This present study reports 109 acute common femoral arterial injuries. Nearly two thirds of the injuries were caused by fragments and slightly more than one half of the injuries were lacerations. It was possible to perform autogenous vein graft repairs in about 57%, end-to-end anastomoses in about 25%, and lateral suture repair in about 10% of the injuries. Prosthetic material was used in only three repairs. 3) The overall complication rate was 28.3%, the amputation rate was 13.2%, and the mortality rate was 2.8%. 4) In the treatment of iatrogenic injuries associated with diagnostic catheterizations of the common femoral artery at Walter Reed Army Medical Center, there were no complications and no mortalities.

Acute Disease↗
PubMed1989

[The anatomical study on the branches of the femoral artery (II). Comparison with the findings of Adachi's classification].

The authors studied the mode of three main branches of the femoral artery (deep femoral, medial circumflex femoral and lateral circumflex femoral artery) in 179 Japanese cadavers during dissecting practice at Gifu University in the last four years. The findings were as follows; Two hundred and seventeen sides in the 352 sides (61.7%) belong to Type I of Adachi's classification on variations in the arrangement of the branches of the femoral artery. Forty-one sides (11.6%) belong to Type II, 55 sides (15.6%) to Type III, 7 sides (2.0%) to Type IV, 8 sides (2.3%) to Type V, 4 sides (1.1%) to Type VI, 5 sides (1.4%) to Type VII and 15 dises (4.3%) to other types. Five cases in 15 sides which belong to other types have been reported in our previous study (Emura et al. 1985). In 3 cases out of 10 sides the deep femoral-medial circumflex femoral trunk, and the ascending and descending branches of the lateral circumflex femoral artery arise from the femoral artery, respectively. In one case out of 10 sides the deep femoral-lateral circumflex femoral trunk and the medial circumflex femoral-inferior epigastric-obturator trunk arise from the femoral artery, respectively. In one case out of 10 sides the lateral circumflex femoral artery and the deep femoral-medial circumflex femoral-inferior epigastric-obturator trunk arise from the femoral artery, respectively. In one case out of 10 sides the medial circumflex femoral-deep circumflex iliac trunk arises from the lateral side of the femoral artery and runs medially behind the femoral artery, and the deep femoral-lateral circumflex femoral trunk arises from the femoral artery. In one case out of 10 sides the deep femoral-ascending (the lateral circumflex femoral artery) trunk, the medial circumflex femoral artery and the deep circumflex iliac-descending (the lateral circumflex femoral artery) trunk arise from the femoral artery, respectively. In one case out of 10 sides the deep femoral-descending (the lateral circumflex femoral artery) trunk, the medial circumflex femoral artery and the ascending branch of the lateral circumflex femoral artery) trunk, the medial circumflex femoral artery and the ascending branch of the lateral circumflex femoral artery arise from the femoral artery, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Classification↗
PubMed2002

Early results of external iliac artery stenting combined with common femoral artery endarterectomy.

PURPOSE: The endovascular approach to external iliac artery (EIA) disease extending into the common femoral artery (CFA) has been avoided because of problems with stent placement across the inguinal ligament. Surgical treatment for this disease distribution includes extensive endarterectomy or bypass procedures or both. We report our initial experience with a combined open and endovascular approach to these patients. METHODS: We performed a retrospective analysis of all patients who underwent intraoperative EIA stenting after CFA endarterectomy/patch angioplasty between 1997 and 2000. Stents were positioned to end at the proximal endarterectomy endpoint, without crossing the inguinal ligament. Technical success, hemodynamic success, and clinical success were determined according to Society of Vascular Surgery/International Society of Cardiovascular Surgery criteria. Life-table analysis was performed for patency. RESULTS: Thirty-four patients (mean age, 68 years; 23 male, 11 female) had combined endovascular and open treatment of iliofemoral occlusive disease. Indications were claudication in 41% and critical limb ischemia in 59%. Femoral reconstruction included endarterectomy with patch angioplasty in all patients. EIA stent deployment incorporated the stenotic iliac segment and the proximal endpoint of the endarterectomy in all patients. Four patients (12%) also needed common iliac angioplasty at the same time for proximal iliac disease, and 14 patients (41%) also needed distal revascularization for associated femoropopliteal or tibial disease. Technical success and hemodynamic success were achieved in 100% of patients. Clinical success was achieved in 97% of patients. The mean postoperative increase in ankle-brachial index in patients with inflow procedures only was 0.36 (range, 0.1 to 0.85). The overall complication rate was 15%. With a mean follow-up period of 13 months (range, 0.5 to 28 months), 1-year primary patency and primary-assisted patency rates were 84% and 97%, respectively. No perioperative mortality was seen. CONCLUSION: EIA stenting as an adjunct to CFA endarterectomy/patch angioplasty allows for more localized surgery than conventional bypass. This approach also allows a better interface between the stent and endarterectomy than staged preoperative stenting. Technical success and early patency rates are excellent.

Aged↗
PubMed2004

Early vitamin E supplementation attenuates diabetes-associated vascular dysfunction and the rise in protein kinase C-beta in mesenteric artery and ameliorates wall stiffness in femoral artery of Wistar rats.

AIMS/HYPOTHESIS: The impact of early vitamin E supplementation on vascular function in diabetes remains unresolved. Therefore, we examined the effects of vitamin E on functional and structural parameters and on chemical markers that are disturbed in diabetes in mesenteric and femoral arteries. METHODS: Segments of both arteries, taken from control and 8-week-old streptozotocin diabetic Wistar rats that were treated or not with vitamin E, were mounted on wire and pressure myographs, after which endothelium-dependent and -independent vasodilation was assessed. Passive mechanical wall properties and the localisation and levels of protein kinase C (PKC)-beta(2) and AGE were evaluated in these vessels. RESULTS: Vitamin E supplementation was associated with improved endothelium-dependent and -independent vasodilatation in mesenteric arteries from diabetic rats. Impaired endothelium-dependent vasodilatation in diabetic mesenteric vessels was associated with PKC-beta(2) up-regulation and this was prevented by vitamin E supplementation. Increased AGE accumulation and plasma isoprostane levels in diabetic rats were not changed by vitamin E. In the femoral artery, vitamin E supplementation had no effect on endothelium-dependent or -independent vasodilatation, but did prevent the wall stiffening associated with diabetes. CONCLUSIONS/INTERPRETATION: Early vitamin E supplementation has a beneficial effect on diabetes-induced endothelial dysfunction in resistance arteries. This benefit may arise from a direct effect on smooth muscle function, as a result of inhibition of the PKC-beta(2) isoform by vitamin E.

Acetylcholine↗
PubMed1994

Infected false aneurysm after puncture of an aneurysm of the deep femoral artery.

Pseudoaneurysm of the femoral artery is a well known complication after diagnostic and therapeutic catheterisation. We report a case of voluminous postcatheterisation false aneurysm, which developed on a pre-existing deep femoral artery aneurysm. Infection by Staphylococcus aureus was demonstrated. After surgical exploration, rupture and external haemorrhage occurred before reconstructive surgery was possible. Due to the septic conditions only a lateral aneurysmorraphy was performed. Postoperative angiogram showed an acceptable result. An aneurysm of the deep femoral artery was also demonstrated on the contralateral side. This was scheduled for elective surgery. In conclusion, this complication could have been avoided by accurate puncture technique. Surgical exploration under local anaesthesia is ill-advised. Especially in patients with advanced vascular disease, non-invasive studies of the puncture site is recommended.

Aged↗
PubMedDate not supplied

Profunda femoral artery pseudoaneurysm after percutaneous transluminal procedures manifested by neuropathy.

The incidence of arterial complications following femoral artery cannulation is low; however, with the increasing number of cardiac diagnostic and interventional procedures, vascular surgeons are being confronted with an increasing number of pseudoaneurysms and arteriovenous fistulas. Swelling and a painful pulsating groin masse are the most frequent presenting symptoms of a common femoral artery false aneurysm. We present the cases of 4 patients who had the unusual finding of a profunda femoral artery pseudoaneurysm after they had undergone cardiac catheterization or percutaneous transluminal coronary angioplasty. The only clinical sign of these patients was femoral neuropathy or neuropalsy caused by femoral nerve compression. Surgical repair of the pseudoaneurysm was successful in all patients. We discuss the reasons for this unusual finding and rare location for a pseudoaneurysm.

Aged↗
PubMed1996

A comparison of pulmonary and femoral artery thermodilution cardiac indices in paediatric intensive care patients.

We have assessed the agreement between pulmonary artery and femoral artery (COLD) thermodilution measurements of the cardiac index (Cl) in a group of paediatric intensive care patients. The COLD method gave consistently higher cardiac index values than the pulmonary artery catheter (PAC); however, the difference was small, with a mean value of 0.19 l/min-1 m-2 or 4.4% of the mean cardiac index. This difference is not clinically important and suggests that, under these circumstances, the COLD system provides an acceptable alternative to the pulmonary artery catheter for measurement of the cardiac index at the bedside.

Cardiac Output↗
PubMed1983

Transluminal coronary angioplasty: comparison of brachial and femoral artery methods.

The brachial and femoral artery methods for (percutaneous) transluminal coronary angioplasty are compared. We attempted 901 angioplasties with 539 (59.8%) via the brachial and 362 (40.2%) via the femoral artery. The stenosis was crossed in 670 attempts (74%); in 410 (76%) via the brachial, and in 260 (72%) via the femoral artery. Successful angioplasty was achieved in 607 attempts (67%): in 370 (69%) via the brachial, and in 237 (65%) via the femoral artery. There was no difference between the techniques in crossing the stenosis or achieving a primary success. The left anterior descending artery stenosis was statistically more likely to be crossed than a stenosis in the right (p less than 0.001), circumflex (p less than 0.05), left main coronary artery (p less than 0.05), or saphenous vein graft (p less than 0.05); the left anterior descending artery stenosis was more likely (p less than 0.05) to be successfully dilated if the lesion were crossed (410 of 445 cases, 92%) than a right coronary stenosis (117 of 136 cases, 80%). The brachial and femoral artery methods are comparable techniques. Interventional angiographers performing coronary angioplasty should utilize the angiographic approach with which they are most familiar.

Angioplasty, Balloon↗
PubMed1996

A rare case of multiple atherosclerotic aneurysms involving the femoral artery.

Atherosclerotic aneurysm of the deep femoral artery is a rare peripheral aneurysm that is likely to have associated aortoiliac aneurysms. The case of a patient who had five atherosclerotic aneurysms located in the abdominal aorta, bilateral common iliac arteries, and the left common femoral and deep femoral arteries is reported. He underwent a semi-emergency operation for the aneurysm of the deep femoral artery, followed by a two-stage operation for the aortoiliac aneurysms. The aneurysm of the deep femoral artery was repaired, and reconstruction of the distal deep femoral artery successfully performed with direct anastomosis to the superficial artery. In this report, the clinical presentation of multiple atherosclerotic aneurysms and the details of surgical reconstruction are described.

Aged↗
PubMed1997

Arteriosclerotic femoral artery aneurysms. A short review.

True arteriosclerotic aneurysms of the femoral artery are rare but they are dangerous lesions that may thrombose, embolise or rupture. They are often bilateral and frequently the patient has other aneurysms in the abdominal aortic or popliteal artery. True femoral aneurysms were originally classified by Cutler and Darling in 1973 as type 1 and type 2 according to their relationship to the common femoral bifurcation. Case reports of isolated superficial and profunda femoral artery aneurysms have been published, but these are exceedingly rare although isolated aneurysms of the profunda femoris artery may be more common in Denmark. True femoral artery aneurysms are attributed to weakening of the arterial wall due to atherosclerosis. True femoral artery aneurysms are relatively rare and are found in elderly smoking men. Aortic aneurysms are approximately 10 times more common. Distal embolization occurs in 0-26% of cases. Acute thrombosis occurs in around 15% of cases. Rupture is uncommon and varies between 10% and 14%. Aneurysmal dilatation of the profunda femoris artery is uncommon and occurs in only 1% to 2.6% of all femoral artery aneurysms. Individualized operative approaches are based on aneurysmal involvement of the superficial femoral or profunda femoris arteries, as well as the presence or absence of coexisting extremity occlusive disease. Aneurysm excision and interposition or bypass graft reconstruction are favored over direct end-to-end reanastomosis.

Aneurysm↗
PubMed1975

Some considerations concerning the deep femoral artery.

The great importance of the deep femoral artery as a collateral vessel in occlusion of the superficial femoral artery is a well-established fact. It has been found in the course of reconstructive operations of this artery that the origin of the two circumflex arteries varies considerably. A study of one hundred cadavers has given some idea of the frequency and nature of these anatomical variations. The importance of this vessel as a collateral is partially explained by the fact that the deep femoral artery has two groups of branches, both of them anastomosing with the branches of the popliteal artery. If the deep femoral artery is to function adequately as a collateral, it has to have a large caliber. An explanation for this may be found in comparative anatomy. In the phylogenetically farther advanced vertebrate animals, all of which have very strongly developed extensors in the posterior extremities, the deep femoral artery which supplies blood to this muscle group is a branch of the iliac artery, and accordingly, a pelvic artery. In man, this artery originates distal to the inguinal ligament from the common femoral artery and supplies blood to less well-developed muscle groups. In this way, phylogeny explains the large caliber of the deep femoral artery, which has originally been a pelvic artery and it also explains the numerous anatomical variations at the site of the bifurcation of the common femoral artery.

Adult↗