What Is a Femoral Aneurysm?

The incidence of femoral aneurysms accounts for more than half of peripheral aneurysms, and is more common in the common femoral artery. Divided into true aneurysms and pseudo aneurysms. The former mostly occurs in patients with atherosclerosis, often accompanied by aneurysms in other parts of the body. The latter are often caused by trauma, iatrogenic injury, immune system disease, infection and other factors. Clinically, acute ischemia of the distal limb can be caused by thrombosis in the aneurysm or thrombolysis of the distal artery, often resulting in amputation. Therefore, active surgical treatment is very important.

Basic Information

English name: femoral arterial aneurysm
Visiting department: surgical
Common locations: Common femoral artery
Common causes: Knife or gunshot wound, atherosclerosis, infection, arterial intubation injury, degenerative degeneration of arterial media, congenital middle defect of artery, etc.

Common symptoms: Pain, numbness, decreased skin temperature, pale skin, weakened or disappeared pulsation of dorsal and posterior tibial arteries, ulcers and necrosis at the toe end, etc.

Causes of Femoral Aneurysms

Trauma

A stab wound or gunshot wound to the femur can cause rupture or complete rupture of the vessel wall. First, a localized, pulsatile hematoma is formed in the surrounding soft tissue, and it is gradually surrounded by the proliferating fibrous tissue. The blood clot liquefies and absorbs to form a pseudoartery Tumor; indirect trauma such as blunt contusion of the femur, crush injury can locally weaken the artery wall, gradually expand to form an aneurysm under pressure, and patients with traumatic femoral aneurysms are younger, both between 20 and 40 years old Pseudoaneurysm.

2. Atherosclerosis

Patients are more than 50 years old and often accompanied by hypertension, coronary heart disease or multiple aneurysms. The intima of the atherosclerotic arterial wall is thickened, and part of the tube wall is degenerative, weak and bulging to form an aneurysm, which is usually a true aneurysm.

3. infection

Nourish blood vessels through endogenous infection pathways such as sepsis, respiratory infections, bacterial endocarditis, or local purulent infections around blood vessels, and exogenous pathways such as open wounds and iatrogenic infections Or a small abscess on the wall of the blood vessel causes a weak artery to become a tumor, and an infectious aneurysm is easy to rupture. In recent years, trauma has gradually become the main cause of infectious femoral aneurysms.

4. Iatrogenic factors

With the widespread development of interventional therapy, reports of arterial cannula injury forming pseudofemoral aneurysms have gradually increased. In addition, there is an increase in vascular reconstruction surgery. Due to local hematomas, infections, or incomplete anastomosis techniques, the anastomotic site is partially or completely weak and broken, and anastomotic pseudoaneurysms are gradually increasing.

5. Other reasons

Such as arterial degenerative degeneration, congenital middle-arterial defects (such as Marfan syndrome, etc.), and autoimmune diseases can also cause femoral aneurysms, but they are rare.

Femoral aneurysm clinical manifestations

Pulsating mass with progressively increasing groin is the most common symptom of this disease. It is generally painless or has mild pain or tenderness. Infectious aneurysms may have persistent pain. The tumor may have numbness and radiation pain when the femoral nerve is compressed; there may be superficial varicose veins of the lower limb when the femoral vein is compressed, and joint movement is limited when the ankle is swollen severely. A large number of thrombosis in the tumor cavity, when the blood vessels are blocked or the thrombus detaches and embolizes the distal artery, can cause distal limb ischemia, such as decreased skin temperature, pale skin, weakened or disappeared pulsations of the dorsal and posterior tibial arteries, and ulcers at the tip And necrosis. Patients with infectious femoral aneurysms may have systemic infections at the same time: fever, physical discomfort, and weight loss.

Femoral aneurysm examination

Laboratory inspection

Increased white blood cell count, accelerated erythrocyte sedimentation, and positive blood culture bacteria suggest the presence of infectious aneurysms.

2. Other auxiliary inspections

(1) Ultrasound Ultrasound can clearly show the morphology, structure, size, and thrombosis of the aneurysm, and can understand hemodynamic information such as flow velocity and flow rate, and can be used to distinguish it from diseases such as atherosclerotic occlusive disease. In addition, it is non-invasive and can be used to screen for aneurysms in other parts.

(2) CT scan is helpful for diagnosis. It can show the size of the aneurysm, whether the wall of the tumor is calcified and the condition of mural thrombus, and the fluid or gas around the infectious aneurysm. It can be distinguished from non-vascular tumors.

(3) MRI examination The size, range, and intrathrombosis of the aneurysm can be displayed without a contrast agent, the layers of the arterial wall can be clearly displayed, and true and false aneurysms can be identified.

(4) Arteriography is the most important method to determine the diagnosis and formulate a surgical plan. It can accurately understand the condition of the aneurysm and surrounding blood vessels, especially the patency of the inflow and outflow tracts. The choice of aneurysm resection and vascular reconstruction It is instructive. It also helps to find aneurysms in other areas.

Femoral aneurysm diagnosis

Medical history

The patient had signs of arteriosclerosis throughout the body, or history of local injury, puncture or intubation, or surgery.

2. Clinical manifestations

Swelling pulsatile masses were found on the inner thighs, especially the femoral triangle. Combining the symptoms of compression with the symptoms and signs of limb ischemia are suspected to be the disease.

3. Auxiliary inspection

Ultrasound Doppler, CT, and angiography can help confirm the diagnosis.

Femoral Aneurysm Treatment

1. Aneurysm resection and vascular reconstruction

It is suitable for tumors with small adhesion to surrounding structures, and autogenous vein or artificial blood vessel transplantation is feasible after resection. The autologous great saphenous vein is preferred for vascular transplantation, and polytetrafluoroethylene (PTFE) vessels are often used for artificial blood vessels.

2. Resection of infectious aneurysm, non-anatomical revascularization

Such as the obturator main-iliac artery bypass grafting.

Prognosis of femoral aneurysm

After surgical treatment of femoral aneurysms, the short-term and long-term effects are good. It has been reported that the patency rate of autologous great saphenous vein or artificial blood vessel after 5 years is about 83%. A small number of patients have long-term arterial embolism before surgery, and there is still chronic limb ischemia after surgery.