Femoral aneurysms

Femoral aneurysms are defined as localized dilations involving all arterial layers, with a diameter exceeding >50% of the adjacent segment or reference standards (which vary depending on the location). They are typically located on the common femoral artery.

Etiologies

Their causes are the same as those for any arterial aneurysm, though they are generally of atherosclerotic origin.

Clinical Presentation

They are usually asymptomatic and discovered during routine evaluations (e.g., screening for peripheral aneurysms after diagnosing an abdominal aortic aneurysm). More rarely, they may be detected following complications such as "blue toe syndrome" or acute ischemia of the affected limb, or through palpation of a potentially pulsating mass.

Complications

Their complications are similar to those of any aneurysm, but thromboembolic complications (risk of acute lower limb ischemia) are the most prominent. Additionally, compression of the femoral nerve may occur, which can manifest as cruralgia. It is also common to find other vascular lesions, including up to 40% of cases associated with peripheral artery disease (sharing atherosclerotic risk factors).

Complementary Tests

Assessment is generally limited to a Doppler ultrasound. Further tests (to investigate a particular cause or other vascular lesions) are only justified if there is a suggestive clinical context.

Therapeutic Management

Management depends on the etiology, morphology, and any complications of the aneurysm. In the majority of cases (atherosclerotic origin, complicated aneurysms, etc.), surgery will be required (resection and graft placement or bypass).

Certain situations (e.g., uncomplicated infectious or inflammatory aneurysms) may warrant medical treatment alone (antibiotic therapy, corticosteroids, etc.) and initial follow-up with ultrasound. Etiological treatment and management of vascular risk factors should also be considered when appropriate.

It is worth noting that femoral pseudoaneurysms (a blood collection secondary to vascular integrity loss, contained by surrounding tissues) are more frequent and typically warrant medical management initially (compression and thrombin injection), with surgery as a second option if this fails.

For more information on rarer etiologies and complications, see also:

  See detailed article: Arterial aneurysms

Bibliography

EMC, Traité d'Angéiologie, 2018

Guzman RJ, Femoral artery aneurysm, UpToDate, 2024