Aneurisma verdadero aislado en arteria femoral superficial asociado a síndrome del dedo azul / True isolated aneurysm in superficial femoral artery associated with blue finger syndrome

Los aneurismas femorales son raros y más aún en la arteria femoral superficial. Estos representan solo el 3 por ciento de todos los aneurismas periféricos. El objetivo de este trabajo fue presentar el caso de un aneurisma verdadero aislado en arteria femoral superficial asociado a síndrome del dedo azul. Se reporta un paciente masculino de 75 años, fumador, con antecedentes patológicos personales de hipertensión arterial, que llega remitido con urgencia desde su área de salud por presentar cambios de coloración (cianosis), frialdad y dolor en la planta y los dedos del pie derecho (microembolias distales). En la tomografía computarizada contrastada se observó aneurisma aislado en la arteria femoral superficial de 4,5 cm de diámetro transversal. Se decidió operar al paciente y se realizó aneurismectomía con interposición de injerto protésico con politetrafluoroetileno, con una configuración de anastomosis término-terminal. Tuvo una evolución clínica posoperatoria inmediata y tardía satisfactoria. Entre los aneurismas femorales, los que afectan a la arteria femoral superficial están menos descritos y pueden complicarse con trombosis, embolización distal o rotura. Existe un alto consenso para su reparación, al eliminar la fuente embólica, prevenir la trombosis, tratar la rotura, eliminar cualquier efecto de masa y restaurar la perfusión de la extremidad distal. Dado que el síndrome del dedo azul puede ser la primera manifestación de esta enfermedad, su rápido reconocimiento, diagnóstico precoz de la fuente embolígena y tratamiento médico-quirúrgico pueden evitar la amputación mayor o la muerte del paciente(AU)

Femoral aneurysms are rare and even more so in the superficial femoral artery. These account for only 3 percent of all peripheral aneurysms. The objective of this study was to present the case of an true isolated aneurysm in the superficial femoral artery associated with blue finger syndrome. A 75-year-old male patient, smoker, with a personal pathological history of arterial hypertension, is reported to be urgently referred from his health area for presenting changes in coloration (cyanosis), coldness and pain in the sole and toes of the right foot (distal microembolisms). The contrasted computed tomography showed an isolated aneurysm in the superficial femoral artery of 4.5 cm transverse diameter. It was decided to operate on the patient and aneurysmectomy was performed with interposition of prosthetic graft with polytetrafluoroethylene, with a configuration of termino-terminal anastomosis. He had a satisfactory immediate and late postoperative clinical evolution. Among femoral aneurysms, those affecting the superficial femoral artery are less described and can be complicated by thrombosis, distal embolization, or rupture. There is a high consensus for their repair by removing the embolic source, preventing thrombosis, treating rupture, eliminating any mass effects and restoring perfusion of the distal limb. Since blue finger syndrome may be the first manifestation of this pathology, its rapid recognition, early diagnosis of the emboligenic source and medical-surgical treatment can prevent major amputation or death of the patient(AU)

A case of deep femoral artery aneurysm found with superficial femoral artery aneurysm / Journal of Rural Medicine

Objective: Deep femoral artery (DFA) aneurysms are extremely rare cases of aneurysms that are difficult to diagnose. The objective of this report was to discuss the timing and method of surgery for this disease.Patient: We encountered an asymptomatic left DFA aneurysm that was discovered along with a symptomatic aneurysm of the right superficial femoral artery (SFA). Both sides of the aneurysm were resected with Dacron knitted artificial vascular grafts (Gelsoft™ Plus, Vasctek, UK) simultaneously.Result: After the operation, the right SFA had good blood flow, but the graft of the left DFA was occluded. The occlusion was considered to be caused by insufficient blood flow in the graft. The patient was discharged without any complications.Conclusion: The coexistence of DFA aneurysms should be examined if other aneurysms are found. DFA aneurysms are at a high risk of rupture. Careful follow-up is required, and intervention is recommended when the diameter exceeds 35 mm.

Persistent mycotic superficial femoral artery pseudoaneurysm after endovascular treatment: a case report / Pseudoaneurisma micótico persistente da artéria femoral superficial após tratamento endovascular: relato de caso

Abstract Mycotic pseudoaneurysms of the superficial femoral artery (SFA) are rare and are usually secondary to colonization of an atherosclerotic plaque during an episode of bacteremia. We describe the case of a 68 year-old diabetic male who presented to the Emergency Department with pyrexia and a painful expanding mass in the left thigh. He had a history of diarrhea and had been treated 16 days earlier for an SFA pseudoaneurysm that had been excluded with a covered stent with no adjunctive antibiotic therapy. Angio CT showed an abscess surrounding femoral vessels and stent thrombosis. Under general anesthesia, we performed extensive debridement, removal of the endovascular material, SFA ligation, and empirical antibiotic therapy. Blood and tissue cultures were positive for Escherichia coli. At the 3-months follow up visit, the patient reported he had no claudication. In selected patients, mycotic pseudoaneurysms can be treated by SFA ligation.

Resumo Pseudoaneurismas micóticos da artéria femoral superficial (AFS) são raros, e geralmente são secundários à colonização de uma placa aterosclerótica durante bacteremia. Relatamos o caso de um paciente masculino diabético de 68 anos que chegou ao Serviço de Emergência com pirexia e massa expansiva dolorosa na coxa esquerda. Apresentava histórico de diarreia e havia sido tratado 16 dias antes para pseudoaneurisma da AFS, que foi excluído com stent coberto e sem antibioticoterapia adjuvante. A angiotomografia computadorizada demonstrou um abscesso ao redor dos vasos femorais e trombose do stent. Sob anestesia geral, realizamos desbridamento extenso, remoção do material endovascular, ligadura de AFS e antibioticoterapia empírica. Culturas de sangue e tecidos foram positivas para Escherichia coli. Na consulta de seguimento aos 3 meses, o paciente negou claudicação. Em pacientes selecionados, pseudoaneurismas micóticos podem ser tratados com ligadura de AFS.

Percutaneous transluminal stenting versus directional atherectomy for lower limb artery TASC Ⅱ Class A and B superficial femoral artery lesions / 中华普通外科杂志

Objective To compare the effect and safety of stenting versus directional atherectomy (DA) in the treatment of TASCⅡ A and B superficial femoral artery lesions.Methods 100 patients with TASC Ⅱ A and B lesions were divided into percutaneous transluminal stenting(PTS) group (n =50) and DA group (n =50).Patients were compared in terms of technical success rate,treatment success rate,first operation cost,postoperative ankle brachial index (ABI),limb salvage rate,survival,and patency.Results The technical success rate in both PTS and DA group was 100％.The treatment success rate was 98％ vs.86％,P＞0.05.Postoperative ABI:0.82 ±0.19 vs.0.80 ±0.27,P＞0.05.First operation cost:(34 820 ± 1 051) yuan vs.(45 635 ± 1 358) yuan,P ＜0.001;All patients were followed-up for up to 2-year,the cumulative patency rate was 81.6％ vs.72.9％ (P＞0.05).Limb salvage rate was 97.9％ vs.93.8 ％,P ＞ 0.05.Conclusion There were no significant differences in the effect and safety of PTS versus DA in the treatment of TASCⅡ A and B superficial femoral artery lesions.

Successful Treatment of a Superficial Femoral Artery Pseudoaneurysm with Balloon Tamponade

The development of post-catheterization arterial pseudoaneurysms is one of the most common vascular access complications following angiographies and endovascular interventions. Different therapeutic options to treat these lesions have been used. We herein report the case of a 79-year-old woman who was referred to our service for evaluation with a post-catheterization superficial femoral artery pseudoaneurysm measuring 4 cm. Owing to the anatomical location of the arterial pseudoaneurysm and the patient’s refusal to undergo open surgery, we treated the lesion using an endovascular approach with a balloon tamponade. The procedure was successful, and the patient recovered well and was discharged from the hospital without complications. At 6-month follow-up she remained symptom-free and without recurrence.

Clinical effects of free superficial femoral artery femoral triangle perforator flap in the repair of skin and soft tissue defects in extremities / 中华烧伤杂志

Objective@#To investigate the clinical effects of free superficial femoral artery femoral triangle perforator flap in the repair of skin and soft tissue defects in extremities.@*Methods@#From January 2016 to November 2017, 14 patients (9 males and 5 females, aged 19 to 54 years) with skin and soft tissue defects in extremities accompanied with tendon and bone exposure were admitted to our unit. The size of skin and soft tissue defects after debridement ranged from 7 cm×3 cm to 10 cm×7 cm. The defects were repaired with free superficial femoral artery femoral triangle perforator flaps, with size ranging from 13.0 cm×2.0 cm to 20.0 cm×4.5 cm. The medial femoral cutaneous nerve was applied to the flap. The perforator flap was grafted onto the medial femoral cutaneous nerve in 6 patients. The donor sites were sutured directly. The survival of flaps and the follow-up of patients were observed.@*Results@#All flaps of 14 patients survived successfully. The recipient sites and donor sites were healed completely in 13 patients, and 1 patient with partial skin necrosis at the edge of flap was healed after treatment. All patients were followed up for 6 months to 1 year after the operation. The flaps were in good shape, with nearly normal color and soft texture and no cicatrix contracture deformity. The flaps recovered protective sense in 6 patients who had medial femoral cutaneous nerve grafting, and the sensory recovery of the flap was slightly worse in the remaining 8 patients. There was no significant complications on the appearance and walking of the donor thigh in 14 patients, only a linear scar was left on the inner thigh, and no numbness was felt in the donor sites of patients.@*Conclusions@#The free superficial femoral artery femoral triangle perforator flap is an ideal therapy for repairing skin and soft tissue defects in extremities.

Ruptura espontânea de aneurisma do segmento médio da artéria femoral superficial: relato de caso / Spontaneous rupture of superficial femoral artery aneurysm: case report

Aneurismas verdadeiros isolados da artéria femoral superficial (AFS) são raros, representando 0,5% dos aneurismas periféricos. Até 2012, existiam relatos na literatura de apenas 103 pacientes com aneurismas verdadeiros isolados da AFS. As principais complicações associadas são: trombose, embolização distal e rotura, sendo a última a mais comum. Os autores relatam o caso de um paciente masculino, de 55 anos, atendido emergencialmente com dor e massa pulsátil em coxa esquerda, condição posteriormente diagnosticada como ruptura de aneurisma da AFS. O paciente foi submetido à correção cirúrgica emergencial com ligadura do aneurisma e revascularização com veia safena magna reversa, com evolução satisfatória

Isolated true aneurysms of the superficial femoral artery (SFA) are rare, accounting for 0.5% of peripheral aneurysms. The literature up to 2012 contains reports of just 103 patients with isolated SFA aneurysms. The main complications are thrombosis, distal embolization, and rupture, which is the most common of the three. The authors report the case of a 55-year-old male patient admitted to the emergency service with pain and a pulsatile mass in the left thigh, subsequently confirmed as rupture of an SFA aneurysm. The patient underwent open aneurysm repair with ligature and revascularization with a reversed saphenous vein bypass

Randomized controlled trial to superficial femoral artery recanalization for lower extremity arteriosclerosis obliterans / 北京大学学报(医学版)

Objective:To evaluate the safety and effectiveness of neglecting superficial femoral artery (SFA) recanalization for chronic lower extremity arteriosclerosis obliterans (ASO).Methods:Thirty-six cases treated for severe stenosis or occlusion of superficial femoral artery resulted from ASO were randomly divided into 2 groups.Twenty of them were treated by endovascular reconstruction of superficial femoral artery and the other 16 cases were not treated with their superficial femoral artery,but were only treated with the accompanied iliac and/or profunda femoral artery lesion.Results:There was no significant difference between the two groups on mean age,gender,ABI before treatment,accompanied diseases,Rutherford classification and trans-atlantic inter-society consensus (TASC) classification (P ＞ 0.05).One week after operation,the reconstruction group had better marked effect and total effective rate [75.0％ vs.12.5％ (P ＜0.001);90.0％ vs.37.5％ (P =0.001)] and lower no effective rate [10.0％ vs.62.5％ (P =0.001)],There was no significant difference between the two groups on effective rate [15.0％ vs.25.0％ (P =0.675)].The deteriorate cases in both groups were zero,and there was no morbidity of complications and death in both groups during the perioperative period.In the 3-month follow up,the reconstruction group had a better marked effect rate [65.0％ vs.25.0％ (P =0.017)];There was no significant difference between the two groups on the effective rate,no effective rate and total effective rate [20.0％ vs.43.8％ (P=O.124);15.0％ vs.31.3％ (P =0.422);85.0％ vs.68.8％ (P =0.422)].The deteriorate cases and morbidity of complications and death in both groups during the perioperative period were still zero.In the 6-and 12-month follow ups,there were no significant differences between the two groups on marked effect and total effective rate [60.0％ vs.37.5％ (P =0.180),80.0％ vs.87.5％(P=0.672);60.0％ vs.43.8％(P=0.332),85.0％ vs.87.5％(P=1.000)].The deteriorate case was zero in both groups,and there was no morbidity of complications and death in both groups.The limb salvage rate in both groups was 100％ during the whole follow up period.The reconstruction group had a higher cost [(53 367.4 ± 24 518.3) yuan vs.(30 397.5 ± 15 354.4) yuan(P =0.011)].There were 8 cases of SFA restenosis/ reocclusion during the follow up,three of which accepted another endovascular treatment,and the reoperation rate was 15.0％.while in the nonreconstruction group,there was no case that needed another endovascular therapy,and the reoperation rate was zero.Conclusion:Only dealing with accompanied iliac and profunda artery lesion and neglecting superficial femoral artery reconstruction is a safe,effective and inexpensive therapy for chronic lower extremity arteriosclerosis obliterans,and should be the preferred alternative for some patients.

Retrograde catheterization via superficial femoral artery for the treatment of ipsilateral superficial femoral artery occlusive disease:its clinical application / 中国医师进修杂志

Objective To investigate the clinical application and value of retrograde catheterization via superficial femoral artery for the treatment of limb chronic total occlusive disease (CTO). Methods Fifty-nine patients with proximal and middle occlusive lesions of superficial femoral artery from Jan. 2013 to Jan. 2015 in department of emergency surgery were retrospectively analyzed. Percutaneous transluminal angioplasty (PTA) together with stent implantation was performed to reopen the all narrowed or obstructed superficial femoral artery.Seventeen patients received ipsilateral retrograde catheterization via superficial femoral artery together. The length of the diseased artery ranged from 6.5 to 13.4 cm, with a mean of (8.3 ± 2.9) cm, including right (11 cases)and left (8 cases) femoral arteries. After the interventional therapy patients were followed up for 1- 24 months. Results All patients were treated successfully. The proximal and middle occlusive lesions of superficial femoral artery were reopened.No serious complications were found including nerve and vessel damage+After the treatment, the ischemic symptoms were markedly improved or even disappeared. In 14/19 of patients the superficial femoral arteries remained patent during the follow-up period. The ankle preoperative brachial index (ABI) was 0.20 to 0.51 (0.39 ± 0.06), while the postoperative ABI was 0.65 to 1.15 (0.74 ± 0.13). The difference in ABI between pre-operation and post-operation was statistically significant (P<0.05). Conclusions Retrograde catheterization via superficial femoral artery is an effective alternative to treat proximal and middle occlusion of ipsilateral superficial femoral artery. It has high successful rate and safety.

Value of the ratio of peak systolic velocity of intra-stenotic superficial femoral artery and popliteal artery(PSV/ PSVpop) in dagnosis of superficial femoral artery sever stenosis / 中华超声影像学杂志

Objective To investigate the diagnostic value of PSV/PSVpop,a new parameter detected by color Doppler ultrasonography,for patients with severe s tenosis (70 ％-99 ％)in superficial femoral artery (SFA).Methods One hundred and eighty-five cases (234 limbs) with SFA stenosis detected by CDU and confirmed by DSA were included in this study.Peak systolic velocity of intra stenotic(PSV),proximal stenotic (PSVpro),and popliteal artery (PSVpop) were measured and recorded respectively.The ratio of PSV/PSVpro,PSV/PSVpop were calculated.Using DSA as the gold standard,the cut off values for the diagnosis of severe stenosis were determined with receiver operating characteristics (ROC) analysis.The efficacy of the above parameters were compared.Results The new parameter PSV/PSVpop≥4 had 96.3％ of sensitivity,91.6％ of specificity,94.4％ of accuracy,95.7％ of positive predictive value,and 91.4％ of negative predictive value and 0.978 of area under the ROC curve(AUC) could define 70％-99％ stenosis of SFA.The AUC of PSV/PSVpop was higher than those of the traditional parameters PSV(0.922) and PSV/ PSVpro(0.920),the difference was statistically significant (P ＜0.01).The AUC of combined parameter PSV/PSVpop + PSV surpassed conventional combined parameter PSV/PSVpro + PSV (0.978 ∶ 0.940,P ＜ 0.05),but had no statistically significant difference with single parameter of PSV/PSVpop (0.978 ∶ 0.978,P ＞ 0.05).Conclusions The diagnostic efficacy of PSV/PSVpop is superior to traditional hemodynamic parameters in the diagnosis of SFA severe stenosis.

Endovascular Management of Spontaneous Superficial Femoral Artery Pseudoaneurysm in a Renal Allograft Patient

We report a case of a superficial femoral artery pseudoaneurysm in 52-year old patient with a history of having renal allograft. The pseudoaneurysm spontaneously developed while standing up from squatting position after defecation, and it was successfully managed by an endovascular repair with an endograft. This case suggests that an atherosclerotic superficial femoral artery is vulnerable to torsion and tension movement during changing position from squatting to standing, which is repeatedly practiced by the people using the Korean traditional toilet. The endovascular therapy is also recommended for elderly patients with poor clinical conditions such as having a renal allograft and diffuse atherosclerosis of peripheral arteries.

Ruptured true superficial femoral artery aneurysm / Aneurisma verdadeiro roto de arteria femoral superficial

Femoral artery aneurysms are rare and generally affect elderly patients. They are often diagnosed in combination with aneurysms in other locations, such as peripheral and aortic aneurysms. This case report describes a young patient whose superficial femoral artery (SFA) had a clinical presentation suggestive of a ruptured aneurysm. The patient underwent standard treatment, with aneurysmectomy and interposition of the ipsilateral saphenous vein. A review of the literature confirms the rarity of this case.

Os aneurismas de artéria femoral são raros e ocorrem geralmente em pacientes idosos. Estão frequentemente associados a outros aneurismas, tanto periféricos como de aorta abdominal. O presente relato refere-se a um jovem portador de aneurisma de artéria femoral superficial (AFS), cuja apresentação clínica foi a ruptura. O paciente foi submetido ao tratamento convencional, com ressecção do aneurisma e interposição de veia safena magna ipsilateral. A revisão da literatura corrobora a raridade do caso.

Venous Thromboembolism and Superficial Femoral Artery Obstruction after Femur Intertrochanteric Fracture: A Case Report / 대한고관절학회지

As the elderly population increases, occurrence of hip fractures has shown a rapid increase, and posttraumatic and postoperative venous thromboembolism can lead to fatal complications. Current prophylactic management includes mechanical and chemical prophylaxis. A 76-year-oldfemale, who was lost to follow-up after diagnosis of pulmonary thromboembolism four years ago, was admitted to our emergency room for a right intertrochanteric fracture. Before the operation, the thromboembolism recurred and was treated with anticoagulation medication. Bipolar hemiarthroplasty and fixation of the greater trochanter with a hook plate were performed 18 days after the trauma. Superficial femoral artery obstruction and venous thromboembolism occurred on the first day after the operation.

Aneurisma de artéria femoral superficial roto: relato de caso e revisão de literatura / Ruptured superficial femoral artery aneurysm: case report and literature review

O aneurisma de artéria femoral superficial é um evento raro que costuma manifestar-se em pacientes com idade avançada, frequentemente associado a outros aneurismas, periféricos ou de aorta abdominal. O caso relatado refere-se a um paciente cujo aneurisma de artéria femoral superficial se apresentou roto e associado a um aneurisma de aorta abdominal. Foi submetido à revascularização cirúrgica fêmoro-poplítea mediante prótese de politetrafluoretileno, com sucesso. A revisão da literatura demonstra que embora haja uma tendência à manifestação aguda da doença, principalmente como ruptura, os resultados com o tratamento cirúrgico são excelentes.

Superficial femoral artery aneurysm is rare and usually occurs in elderly patients, often associated with peripheral or abdominal aortic aneurysms. In the reported case, the patient presented with a ruptured superficial femoral artery aneurysm associated with an abdominal aortic aneurysm. A successful femoropopliteal bypass was performed using a polytetrafluorethylene graft. Literature review shows that, despite the tendency for acute onset of the aneurysm, primarily with a rupture, surgical results are excellent.

Interventional therapy for atherosclerotic occlusive disease of the superficial femoral artery / 中华普通外科杂志

Objective To explore the methods and mid-term results of interventional therapy for atherosclerotic occlusive disease of the superficial femoral artery(SFA).Methods From January 2005 to August 2008,Nineteen cases with 22 diseased lower limbs were admitted.According to Fontaine stage system,there were 6 stage Ⅱb limbs(moderate to severe intermittent claudication),8 stage Ⅲ limbs(rest pain),and 8 stage Ⅳ limbs(6 with ulcer and 2 with gangrene).The mean lesion length was 8.8 cm(5～13 cm).On the basis of the TransAtlantic Inter-Society Consensus(TASC)femoropopliteal classification,the lesions were classified as type B in 4 limbs,type C in 17,and D in 1.Follow up examinations with color duplex ultrasound and/or arteriography were carried out to determine the patency.The improvement of clinical symptoms after operation was analyzed.Results 17 limbs were revascularization successfully,2 limbs were turned to bypass operation,3 limbs were judged untreatable.The technical success rate is 77.3%,and the clinical improvement of symptoms was achieved in 100% of the 17 limbs on which the procedure was successful.The 17 limbs were followed up for a mean of 12.5 months(range 3-33 months).One patient died of cardia infarction one month postoperatively.SFA occlusion happened in 4 limbs.At one year postoperatively,the patency rate was 75%(13/17)after primary operation.Conclusions Primary endovascular treatment of SFA occlusion diseases is a safe,minimally invasive,and effective method.

Pseudoaneurysm of Superficial Femoral Artery Following Proximal Femoral Nail Fixation

Pseudoaneurysm of the femoral artery is a rare complication following the fixation of the fracture of proximal femur or protruded bony fragment and reports injuring on superficial femoral artery is very rare compared to deep femoral artery complicated by the insertion of distal interlocking screw. The chance of injuring superficial femoral artery may increase by deep insertion of drill bit or the repetitive arterial pulsation on prominent distal interlocking screw tip during the perioperative period. Authors experienced one case of injury on the superficial femoral artery postoperative 42 hours followed by the use of proximal femoral nail advocated by the AO group recently and would like to call attention upon the possibilities of vessel injury complicated with the use of the distal interlocking screw.

Pseudoaneurysm of the Superficial Femoral Artery Following Gamma nail Fixation for Trochanteric Fracture: A Case Report / 대한정형외과학회잡지

Pseudoaneurysm of the femoral artery complicating internal fixation of the trochanteric fracture of the femur results mainly from a penetrating injury by the drill bit or screw and involves particularly the profunda femoris artery. Recently, we experienced a case of pseudoaneurysm of the superficial femoral artery following insertion of the Gamma nail for trochanteric fracture of the femur and scrutinized the causes of this injury. The superficial femoral artery lies in close proximity to the femur by adduction of the involved limb against the perineal post on the fracture table during Gamma nailing.

Comparative study of vasodilatation function of the brachial and superficial femoral arteries in elderly patients with atherosclerotic disease of lower extremity / 解放军医学杂志

Objective To evaluate endothelium-dependent dilation (flow-mediated dilation, FMD) and endothelium-independent dilation(nitroglycerin-mediated dilation, NMD) of the brachial and superficial arteries in elderly patients with atherosclerotic disease(LEASD) of the lower extremity, and to evaluate the correlation between brachial and superficial femoral FMD and NMD and their characteristics. Methods Both FMD and NMD of the brachial artery and the superficial femoral artery were determined in 33 old LEASD patients with the high-resolution ultrasound, and the results were compared with that of 40 healthy elderly controls and 30 non-LEASD elderly patients with cardiovascular risk factors, respectively. Results Both FMD and NMD of the brachial artery and the superficial femoral artery were significantly lower in 33 elderly LEASD patients compared with those of 40 healthy elderly controls and 30 non-LEASD elderly patients but with cardiovascular risk factors (P