Case reports
Case1
A 69-year-old man complained about tenderness in his left thigh and
computed tomography angiography(CTA) showed a left large fusiform
DFAA(Figure 1A). The maximum size of the aneurysm was 60mm×55mm in
diameter and the aneurysm contained abundant thrombus within the
sac(Figure 1B). This symptomatic huge DFAA was surgically repaired to
prevent rupture and release local compression. The open repair was
performed through longitudinal groin incision. The DFAA adhered to
surrounding tissue and the femoral nerve was dissected from the
aneurysm(Figure 1C). Femoral veins were also gently dissected and cared
to avoid venous injury and perioperative venous thrombosis. The
aneurysmectomy was performed and interposed a 6mm ring-supported
expanded polytetrafluoroethylen (ePTFE) graft into DFA(Figure 1D).
Case2
A 67-year-old man was referred to our hospital with sudden right thigh
pain. CTA revealed bilateral DFAA and the right DFAA was ruptured(Figure
2AB). Emergency surgery was carried out for the ruptured right DFAA.
Right common femoral artery(CFA) and proximal DFA were dissected through
groin incision. 5Fr. sheath was inserted via the right CFA into the
distal artery of DFA. The distal branch of DFAA was embolized with 7mm
Amplutzer vascular plug 4(Abbott, St Paul, MN, USA). Finally proximal
DFA was ligated. The patient was discharged with no sign of limb
ischemia.
The follow-up CTA showed the enlargement of the left DFAA measuring 25mm
in diameter and occlusion of left superficial femoral artery(SFA). The
left ankle brachial index showed 0.51. Endovascular management was
selected for the left DFAA as a concomitant treatment with endovascular
treatment of left SFA occlusion. A 7Fr sheath was inserted into left CFA
via small groin incision and the occlusive long lesion in SFA was
treated with balloon angioplasty following 6mm×250mm stent graft
deployment (Viabahn, WL Gore & Associates Inc.). Nest the 7Fr sheath
gently advanced to the distal artery of DFAA and 7mm×500mm
self-expanding stent graft was deployed from the distal artery to
proximal neck of DFAA. Postoperative CT revealed exclusion of DFAA blood
flow and patent stent grafts(Figure 2CD). The left ankle brachial index
rose to 0.97 and the patient was discharged without any leg ischemic
symptoms.
Case3
A 87-year-old man was referred to our institute because CTA revealed
left DFAA measuring 50mm in diameter. The patient was asymptomatic and
clinical frailty scale is 7 due to high age and sequelae to cerebral
infarction. Endovascular management was considered to be impossible
because DFAA enlarged proximally just bifurcation from CFA(Figure3AB).
Only aneurysmectomy was done with surgical closure of distal branches of
DFA. Aneurysmectomy and proximal and distal ligation of DFAA were
performed. Reconstruction of DFA was not done because the patient was
low activity and SFA had no stenosis