Presentation
A case of bilateral symptomatic aneurysms of common femoral arteries: surgical management
We describe the surgical management of bilateral common femoral aneurysms. When should they be operated? What is your preferred method?
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Thank you Stratos for the nice presentation? I have 3 questions for you:
1. Which is the surveillance protocol for such an aneurysm? Which diameter is critical for you?
2. Dacron or PTFE? What is the graft of your choice?
3. Do you perform a screening for AAA and popliteal aneurysm in those patients?
Hi Theo and thanks for your attention. I usually suggest a FU examination at 1-, 6- and 12months postoperatively. If a femoral aneurysm is asymptomatic most authors suggest intervention at a diameter greater than 2.5-3.0cm. Depending on the size of the inflow and outflow vessel to be clamped, i prefer Dacron for large diameters or PTFE if the vessel sizes are smaller. I certainly perform a CTA scan to rule out comcomitant aneurysms in remote locations, since femoral aneurysms -although rare, accounting for 3-4% of all peripheral aneurysms- are bilateral in 1/3 of cases while associated with aortic- or popliteal aneurysms in 66%. Therefore, a CTA is mandatory.
Dear Stratos,
I think that a CTA is a valuable tool for the plan of the procedure, nonetheless duplex ultrasound scanning is probably a sufficient screening modality.
You are absolutely right, dupplex can certainly rule out popliteal aneurysms as well abdominal aortic ones. Once the indication has been set, a CT has a valuable role to describe better the iliacs and,thus, describe better the anatomy of an existing AAA (small or large). Thanks for pointing out, Kostas!