From the Guidelines
Surgical intervention is the recommended treatment for femoral artery aneurysms, especially for those larger than 3.0 cm in diameter or symptomatic, due to the significant risk of complications including rupture, thrombosis, or embolization 1.
Treatment Options
The primary treatment options include:
- Open surgical repair: replacing the diseased artery segment with a synthetic graft through an incision in the groin or thigh
- Endovascular repair: a less invasive option where a stent-graft is inserted through a small incision in the groin and guided to the aneurysm site using imaging The choice between these approaches depends on the patient's anatomy, aneurysm characteristics, surgical risk factors, and comorbidities.
Pre- and Post-Operative Care
Prior to surgery, patients may be prescribed antiplatelet medications like aspirin (81-325mg daily) or statins to reduce cardiovascular risk 1. Post-operatively, patients require regular follow-up imaging (typically ultrasound every 6-12 months) to monitor for complications or recurrence.
Conservative Management
Small aneurysms (less than 3.0 cm) may sometimes be managed conservatively with regular monitoring and risk factor modification, including smoking cessation, blood pressure control, and cholesterol management 1. However, most symptomatic aneurysms or those larger than 3.0 cm generally require intervention due to the increased risk of complications that could lead to limb loss or death if left untreated 1.
Key Considerations
- The presence of mural thrombus conceivably could represent a risk for distal emboli unless elective repair is performed 1
- Infected femoral pseudoaneurysms may occur as the result of arterial puncture during drug abuse and must be treated by extensive operative debridement, often in conjunction with either autogenous in situ reconstruction or extra-anatomic bypass grafts to avoid CLI 1
From the Research
Treatment Options for Femoral Artery Aneurysm
- Open repair: This traditional method involves surgically exposing the aneurysm, ligating it, and revascularizing the affected area via bypass or graft interposition 2, 3.
- Endovascular repair: This minimally invasive approach uses a covered stent to exclude the aneurysm sac, and can be an alternative to open repair 2, 4.
- Percutaneous femoral access: This technique involves accessing the femoral artery through a small puncture in the skin, and can be used for endovascular repair 5, 6.
Comparison of Treatment Outcomes
- A study comparing open and endovascular repair of superficial femoral artery aneurysms found no significant differences in technical success, limb salvage, and primary patency rates between the two groups 2.
- Another study comparing open and endovascular treatment of traumatic femoral artery aneurysms found that the endovascular approach had a shorter hospital stay and lower complication rate, but a higher incidence of thrombosis 4.
- A study on percutaneous femoral access for endovascular aortic aneurysm repair found that prior open surgical femoral exposure did not negatively impact technical success and clinical outcomes 6.
Considerations for Treatment Choice
- The choice of treatment depends on various factors, including the location and size of the aneurysm, the patient's overall health, and the presence of any comorbidities 2, 4.
- The superficial femoral artery approach may be associated with a lower complication rate and faster recovery compared to the common femoral artery approach 5.
- The endovascular approach may be a valid alternative to open repair, offering good results and shorter hospitalization, but may have a higher incidence of thrombosis 2, 4.