Presentation
Spontaneous Rupture of SFA
This is an 81-Year-old patient presented with a spontaneous rupture of the superficial femoral artery of the left leg and on arrival to hospital he developed DVT in the same leg with pulmonary emboli which makes the anticoagulation policy to be quiet interesting, IVC filter has been deployed and covered stent has been implanted in his ruptured artery with endoleak type 1 B which settled conservatively, I hope you enjoy watching this case and looking forward to all your great comments
Mr. Mohamed Omar Elfarok M.Sc, FRCSEng, FRCSEd, IME
Consultant Vascular Surgeon
Royal College of Surgeons of England Examiner
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Mohammed amazing case. Why did you use the two needles? I did not understand it very well. Second what about the pathology behind this aneurysm? Could it be mycotic?
Dearest Prof Bisdas ,
1- the use of the two needles with to mark the proximal and distal part of the ruptured segment in the SFA, so I need to cover the distance between these two needles and 2 cm proximal and distal landing zones
2- I totally agree it can be rupture of mycotic aneurysm of this patient although it can also be spontaneous rupture of SFA without previous aneurysmal dialatation , there was no eivdece of previous aneurysm in the patient SFA . very very rare case
thank you very much my dearest Prof Bisdas
Dearest Prof Bisdas ,
1- the use of the two needles with to mark the proximal and distal part of the ruptured segment in the SFA, so I need to cover the distance between these two needles and 2 cm proximal and distal landing zones
2- I totally agree it can be rupture of mycotic aneurysm of this patient although it can also be spontaneous rupture of SFA without previous aneurysmal dialatation , there was no eivdece of previous aneurysm in the patient SFA . very very rare case
thank you very much my dearest Prof Bisdas
Dear Professor Omar, very nice case. May I suggest that the diagnosis is ruptured SFA aneurysm from the start. and the concomitant DVT was created by the pressure of the adjacent aneurysm !
You did the best cover to the leaking area, but I would take care more to the Proximal end (feeding) cover than the distal one.
Thank you, I appreciate much your really great way to spread knowledge, learn and benefit everybody including myself.
Dearest Prof Sharkawey , thank you very much for your comment, actually this patient is a grandfather of a cardiologist and he had duplex scan arterial left leg before this event and there was no aneurysm found just diffuse atherosclerosis, so it is really spontaneous rupture of SFA which is very rare event only 5 cases reported in literature whorld wide , as we get older our arteries rupture due to wall weakness without aneurysmal formation, and also if you notice this is SFA zone two middle zone which is very rare to develop aneurysm it is usually in zone 1, and thank you again for your comment
Great job Prof. Thank you so much for this sharing. I am really apperciate that and waiting for the next.
Thank you so much dear Prof. Alfarouk , I have 2 questions :
1) Wallstent covered stent is 10 * 10 , Do you think it’s perfect for SFA as regard sizing
2) Did you needed to evacuate hematoma and make open surgery ?
Thanks
Thank you for a great comment
1- the diameter of this patient SFA was 8 mm, i thought 10 mm will do ok , did not want to use any bigger diameter because this is a friable artery
2- there is no need to evacuate the haematoma unless it becomes infected or cause complication, it has resolved after 2 months
Thank you so much dear Prof. Alfarouk , I have 2 questions :
1) Wallstent covered stent is 10 / 10 , Do you think it’s perfect for SFA as regard sizing
2) Did you needed to evacuate hematoma and make open surgery ?
Thanks