Ruptured Superficial Femoral Artery Anastomotic Pseudoaneurysm after 30 Years

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Endovascular Therapy

Background:

• Anastomotic pseudoaneurysms are a rare but serious complication following vascular reconstructive surgery.
• Femoral pseudoaneurysms, particularly when ruptured, carry a high mortality rate and necessitate urgent surgical intervention.

Observation:

• A 60-year-old male presented with severe left thigh pain due to a ruptured superficial femoral artery pseudoaneurysm.
• The patient had a history of a superficial femoral artery interposition vein graft placed 30 years prior.
• Preoperative imaging revealed contrast extravasation into an intramuscular hematoma, complicated by extensive scarring from previous surgeries.

Findings:

• Endovascular repair using two Viabahn covered stents was successfully performed via percutaneous access.
• The procedure effectively excluded the pseudoaneurysm, with no evidence of extravasation on completion angiography.
• The patient experienced a favorable recovery and was discharged two days postoperatively.

Implications:

• This case demonstrates the efficacy of endovascular stenting for ruptured femoral anastomotic pseudoaneurysms, even in complex scenarios with delayed presentation.
• It challenges the typical timeline for pseudoaneurysm formation, presenting a unique instance 30 years post-operation.
• Endovascular repair offers a less invasive alternative to open surgery for these challenging lesions.