Isolated aneurysms of the deep femoral artery are extremely rare when compared to other aneurysms of the arterial system. The primary complications of these aneurysms include rupture and distal embolization. We present a case of a rapidly expanding primary aneurysm of the Profunda artery.

A 72 year old gentleman presented to the emergency room with a two week history of an expanding pulsatile swelling in his left groin. Initially the mass was painless but with gradual increase in size eventually become pulsatile and painful enough for him to seek medical attention. His past medical history included hypertension, hypothyroidism and benign prostatic hyperplasia for which he was on appropriate medications. The patient had no prior history of trauma or catheterization to his left groin. He denied any fevers or chills. Labs were within normal limits with a white blood cell count of 7.4. He was hemodynamically stable and in no apparent distress. Focused physical exam revealed a large, pulsatile, non-tender mass in his anterior-lateral groin. He had strongly palpable distal pulses.

The patient underwent a CTA which revealed a large fusiform aneurysm of the profunda artery measuring 12.8cmx11cm. There was also arteriomegaly, but no other aneurysms. There was a question of the rupture of this aneurysm on the radiologist dictation. He was taken to the operating room emergently. In the OR an arterial line was placed and the patient was prepped and draped in usual fashion. After induction of general anesthesia, control of the external iliac artery (EIA) was achieved through a Gibson incision. A sterile tourniquet was placed just above the knee for distal control. The patient was heparinized the

The EIA was clamped and the tourniquet was inflated to 250mmHg. A 10cm longitudinal incision was made over the aneurysm. The sartorious was mobilized laterally. The femoral nerve, which was draped over the aneurysm, was mobilized laterally and the aneurysm was entered. The thrombus within the aneurysm was removed. There was significant brisk back bleeding from the profunda outflow. This was over sewn with running 4-0 prolene suture with a Blalock stitch. The inflow was over sewn in similar fashion. There was no evidence of rupture of the artery.

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The EIA clamp and tourniquet were removed with good hemostasis. At this time, the superficial femoral artery was found to be intact at the medial aspect of the wound, and there was a palpable popliteal pulse. Swabs of the wound and thrombus were sent for cultures. Given rapid expansion of this unusual aneurysm the decision was made to place a temporary vacuum dressing (VAC, KCI) in the wound. The patient did well from the operation and had strongly palpable distal pulses. The intraoperative cultures did not grow any organisms. The patient was taken to the operating room on postoperative day number seven by plastic surgery where the wound was primarily closed. The patient was discharged to a rehabilitation facility on postoperative day ten. He had a duplex of his popliteal arteries which did not demonstrate any aneurysms.

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Profunda femoral artery aneurysms (PFAA’s) are rare, comprising only 0.5% of peripheral artery aneurysms. They usually occur concurrently with other peripheral artery aneurysms (aortic, iliac, common femoral, popliteal aneurysms), identified in 45-81% of cases [1]. The rarity of this condition owes it to its anatomical location and characteristics. The artery has few elastic fibers and a rich muscular layer, and anatomically is covered by several muscles [2-4].

Profunda femoral artery psuedoaneurysms are much more common, and are most commonly reported following trauma, percutaneous access procedures and following orthopedic operations involving the proximal thigh [5].

Isolated expanding profunda artery aneurysm

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PFAA’s can be difficult to recognize because symptoms tend not to arise until the aneurysm expands. This characteristic gives rise to greater complication rates, as these aneurysms have a higher rate of rupture when compared to other peripheral artery aneurysms. Complications of PFAA’s include femoral nerve neuropathy, venous stasis due to compression of the superficial femoral vein, and acute limb ischemia secondary to thrombosis or embolization. Recognizing PFAA’s clinically is very difficult due to their rarity determining whether a pulsating groin mass pertains to one or the other femoral arteries. To establish the diagnosis of PFAA’s, color doppler ultrasound, CTA or angiography can be used. Angiography is an invasive procedure, and can miss the diagnosis as the thrombus can mask the aneurysm. CT angiography has the additional benefit to identifying other coexistent aneurysms and occlusive arterial lesions, along with giving detailed anatomical data [6].

Treatment of PFAA’s is usually surgical, and depends on the patency of the ipsilateral superficial femoral artery (SFA). If the SFA is patent, ligation and exclusion of the profunda femoral artery is acceptable. If, however, the SFA is not patent, more advanced reconstruction procedures of either the SFA or profunda femoral artery are required [7].

Isolated true aneurysms of the profunda femoral artery are exceptionally rare, but should be considered as a differential diagnosis in a patient with a pulsating groin mass, with or without symptoms of neuropathy, venous stasis, or limb ischemia.

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2. Roseman JM, Wyche D. True aneurysm of the profunda femoris artery. Literature review, differential diagnosis, management. J Cardiovasc Surg 1987;28:701-5.
3. Johnson CA, Goff JM, Rehrig ST, Hadro NC. Asymptomatic profunda femoris artery aneurysm: diagnosis and rationale for management. Eur J Vasc Endovasc Surg 2002;24:91-2.
4. Toda R, Yuda T, Watanabe S, Hisashi Y, Moriyama Y, Taira A. Surgical repair of a solitary deep femoral arterial aneurysm: report of two cases. Surg Today 2000; 30:481-3.
5. Posner SR, Wilensky J, Dimick J, Henke PK. A true anuerysm of the profunda femoris artery: a case report and review of the English language literature. Ann Vasc Surg 2004;18:740-6
6. Cho YP, Choi SJ, Kwon TW, Han MS, Kim YH, Kim CW, Lee SG. Deep femoral artery aneurysm presenting as lower limb swelling: a case report. Yonsei Medical Journal, vol. 47, no. 1, pp. 148-151, 2006.
7. Ganeshan A, Hawkins M, Warakaulle D,Uthappa MC. Endovascular therapy for a profunda femoris aneurysm which ruptured following intravenous thrombolysis. The British Journal of Radiology, vol. 80, pp. 147-149, 2007.