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What Causes Pseudoaneurism Of Femoral Artery?
Question: Hello, I am a 69 years old male with the following health history:
1983 - Abdominal Aortic Aneurysm
1983 - Dacron Aortofemoral Y Graft (AAA repair)
1989 - Type 2 Diabetes Mellitus
1998 - Stroke (Right Hemiparesis)
1999 - Ischaemic Heart Disease
2006 - B12 Deficiency
I also have a long history of CKD 3b. GFR ~40
1. Type 2 Diabetes, under control - Taking Gliclazide tablets
2. High Blood Pressure, under control when measured at home - Taking Enalapril and Atenolol
3. Cholesterol, under control - Taking Atorvastatin
4. Blood Thinner - Taking Dispersible Aspirin Tablets
I was admitted to hospital earlier this week for what appeared to be a femoral aneurysm in my right leg. Originally in 1983 I had an Open Abdominal Aortic Aneurysm repair performed with a graft being put in to replace part of my aorta. Today's scans revealed all 3 parts of the graft that was stitched onto the original arteries are leaking. I will be told my treatment options tomorrow, however I want to know your own opinions based on your experiences on what would be a safe treatment.
My heart stopped during my open AAA repair in 1983 and I was much younger at that time and didn't have my current medical conditions so I am a bit scared.
Thank You
Sorry I forgot to add that I had a heart attack in 2002 - Acute inferoposterior infarction
1983 - Abdominal Aortic Aneurysm
1983 - Dacron Aortofemoral Y Graft (AAA repair)
1989 - Type 2 Diabetes Mellitus
1998 - Stroke (Right Hemiparesis)
1999 - Ischaemic Heart Disease
2006 - B12 Deficiency
I also have a long history of CKD 3b. GFR ~40
1. Type 2 Diabetes, under control - Taking Gliclazide tablets
2. High Blood Pressure, under control when measured at home - Taking Enalapril and Atenolol
3. Cholesterol, under control - Taking Atorvastatin
4. Blood Thinner - Taking Dispersible Aspirin Tablets
I was admitted to hospital earlier this week for what appeared to be a femoral aneurysm in my right leg. Originally in 1983 I had an Open Abdominal Aortic Aneurysm repair performed with a graft being put in to replace part of my aorta. Today's scans revealed all 3 parts of the graft that was stitched onto the original arteries are leaking. I will be told my treatment options tomorrow, however I want to know your own opinions based on your experiences on what would be a safe treatment.
My heart stopped during my open AAA repair in 1983 and I was much younger at that time and didn't have my current medical conditions so I am a bit scared.
Thank You
Sorry I forgot to add that I had a heart attack in 2002 - Acute inferoposterior infarction
Brief Answer:
depends on size of pseudoaneurism
Detailed Answer:
Hi and welcome.
Pseudoaneurism of femoral artery is not uncommon as well as heamthomas around previously implanted vascular grafts. However, if there was not recent trauma then it is bit unusual that leaks occur at all 3 levels where anastomosis was performed,especially after such long period.
First, peripheral circulation should be evaluated. if there is no concerns about legs ischemia or significant anaemia then surgery can be delayed and condition may be treated conservatively. If there are symptoms such as pain, anemia, hypotension or critical leg ischemia then surgery must be performed as soon as possible. It is important to determine are these scans showing just pseudoaneurism or there is active bleeding from edges of graft. If there is only pseudoaneursim then you can wait and do control angiography in short time.
If there is active bleeding then graft must be changed.
SOme institutions can implant vascular grafts less invasively by interventional radiologists or stents can be placed at areas where leak is detected,but you should ask your doctor aout these options. Wish you good health. Regards
depends on size of pseudoaneurism
Detailed Answer:
Hi and welcome.
Pseudoaneurism of femoral artery is not uncommon as well as heamthomas around previously implanted vascular grafts. However, if there was not recent trauma then it is bit unusual that leaks occur at all 3 levels where anastomosis was performed,especially after such long period.
First, peripheral circulation should be evaluated. if there is no concerns about legs ischemia or significant anaemia then surgery can be delayed and condition may be treated conservatively. If there are symptoms such as pain, anemia, hypotension or critical leg ischemia then surgery must be performed as soon as possible. It is important to determine are these scans showing just pseudoaneurism or there is active bleeding from edges of graft. If there is only pseudoaneursim then you can wait and do control angiography in short time.
If there is active bleeding then graft must be changed.
SOme institutions can implant vascular grafts less invasively by interventional radiologists or stents can be placed at areas where leak is detected,but you should ask your doctor aout these options. Wish you good health. Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Hello Dr Romic,
Thanks for your response. The vascular consultant saw me today and recommended that I have open surgery to replace/repair the whole graft like in 1983. He said that "keyhole" surgery was not possible because theres problems on all 3 areas. He also said this happens to most people after ~20 years. I declined the open surgery for now so I can seek other medical opinions for a less invasive option. The discharge report for my GP states: "Duplex scan showed a >5cm patent aneurysm likely to be an anastomatic rupture from distal graft. CT angio showed a 6cm Aortic Aneurysm". The doctor will be sending me a CD with my CT scans etc.. so I can show other doctors. This was all done in the UK if that matters. My son is the USA and I will be sending the CD to him so he can show doctors over there.
I have been reading several articles showing great success for people in my situation with an Endovasular approach. I don't understand why something like that can't be performed with me. Links below:
http://www.sciencedirect.com/science/article/pii/S0000
http://www.sciencedirect.com/science/article/pii/S0000
http://link XXXXXXX com/article/10.1007%2Fs595-001-8070-7#page-1
http://www.ejves.com/article/S1078-5884(06)00283-8/abstract
http://ac.els-cdn.com/S0000/1-s2.0-S0000-main.pdf?_tid=59747f90-de5d-11e4-88c1-00000aacb361&acdnat=0000_2c8e0000cfd209ae35beb72834a67
In 1983 I was only ~38 years old and it still took me a year to get back to normal. I am 69 now and even if I pull through surgery, the aftermath would be unbearable for me.
What are your opinions and do you have any recommendations for surgeons in the UK or USA?
Thank You
Thanks for your response. The vascular consultant saw me today and recommended that I have open surgery to replace/repair the whole graft like in 1983. He said that "keyhole" surgery was not possible because theres problems on all 3 areas. He also said this happens to most people after ~20 years. I declined the open surgery for now so I can seek other medical opinions for a less invasive option. The discharge report for my GP states: "Duplex scan showed a >5cm patent aneurysm likely to be an anastomatic rupture from distal graft. CT angio showed a 6cm Aortic Aneurysm". The doctor will be sending me a CD with my CT scans etc.. so I can show other doctors. This was all done in the UK if that matters. My son is the USA and I will be sending the CD to him so he can show doctors over there.
I have been reading several articles showing great success for people in my situation with an Endovasular approach. I don't understand why something like that can't be performed with me. Links below:
http://www.sciencedirect.com/science/article/pii/S0000
http://www.sciencedirect.com/science/article/pii/S0000
http://link XXXXXXX com/article/10.1007%2Fs595-001-8070-7#page-1
http://www.ejves.com/article/S1078-5884(06)00283-8/abstract
http://ac.els-cdn.com/S0000/1-s2.0-S0000-main.pdf?_tid=59747f90-de5d-11e4-88c1-00000aacb361&acdnat=0000_2c8e0000cfd209ae35beb72834a67
In 1983 I was only ~38 years old and it still took me a year to get back to normal. I am 69 now and even if I pull through surgery, the aftermath would be unbearable for me.
What are your opinions and do you have any recommendations for surgeons in the UK or USA?
Thank You
Brief Answer:
I understand your concerns
Detailed Answer:
Hi.
Yes, there are reported cases of endovascular grafting even after previous open surgeries,or primary endovascular treatment. Primary endovascular repair is feasable and almost routine today in some centres,and is becoming even first choice in selected patients. Endovascular repair after open surgeries,especially aortobifemoral grafts is less commonly performed and bit more experience is required. SO this is done maybe in few institutions in USA,and I am not sure in UK.It depends on experience of interventional radiologist and availability of endovascular graft which must be done constructed personally for each patient. I am not sure how you can organise all this.
Endovascular treatment has less morbidity and complications rate and faster is recovery,but open repair should be accepted since probably there is no another option so you should not delay if surgery is indicated.
I understand your concerns
Detailed Answer:
Hi.
Yes, there are reported cases of endovascular grafting even after previous open surgeries,or primary endovascular treatment. Primary endovascular repair is feasable and almost routine today in some centres,and is becoming even first choice in selected patients. Endovascular repair after open surgeries,especially aortobifemoral grafts is less commonly performed and bit more experience is required. SO this is done maybe in few institutions in USA,and I am not sure in UK.It depends on experience of interventional radiologist and availability of endovascular graft which must be done constructed personally for each patient. I am not sure how you can organise all this.
Endovascular treatment has less morbidity and complications rate and faster is recovery,but open repair should be accepted since probably there is no another option so you should not delay if surgery is indicated.
Note: For further inquiries on surgery procedure and its risks or complications book an appointment now
Above answer was peer-reviewed by :
Dr. Raju A.T
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