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?

Comments

    Dr. Theodosios Bisdas
    June 7, 2018

    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!

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