PERIPHERAL ARTERIAL ANEURYSMS
Peripheral aneurysms can be broadly categorized, based on location, into upper and lower extremity aneurysms. In any artery, the Society for Vascular Surgery clinical practice guidelines defines an aneurysm as a focal dilation 1.5 times the normal diameter of the disease-free proximal adjacent segment.1 True aneurysms consist of the outpouching of all three layers of the vessel wall including tunica intima, media, and adventitia. False aneurysms (pseudoaneurysms), on the other hand, include dilation of one or two layers of the vessel wall (Figure 30-1a-b). The most common false aneurysms will be discussed separately after the corresponding artery.
True aneurysm and false aneurysm. (A) Depicts transverse and longitudinal illustrations of a normal, true aneurysm, and false aneurysm vessel. (B) Schematic representation of fusiform and saccular aneurysms. (Reprinted with permission, Cleveland Clinic Foundation ©2022. All Rights Reserved.)
The incidence of aneurysms in peripheral arteries is rare in comparison to that of abdominal aortic aneurysms (AAA).2 Hence, diagnosis of a peripheral aneurysm warrants screening in other vascular beds due to the high incidence of concomitant diseases. The most common underlying pathology of peripheral aneurysm formation is a degenerative or atherosclerotic disease (Table 30-1). In order of frequency, the most common peripheral aneurysm locations are the popliteal/superficial femoral, common femoral, and axillary arteries. Reports on distal aneurysms involving profunda femoral, tibial, peroneal, brachial, and ulnar arteries are limited to case reports.
Peripheral aneurysms may be asymptomatic or lead to local/end-organ complications. Local compression of surrounding venous or neurologic structures and thromboembolic complications are the most common presenting symptoms. Unlike the aorta, peripheral aneurysms are less prone to rupture. The decision to repair peripheral aneurysms depends on the size of the aneurysm, rate of expansion, presence of symptoms, and the patient’s overall medical condition. Treatment may be initiated through open, endovascular, or hybrid surgical techniques, with two primary goals: (1) to exclude the aneurysm and (2) to restore arterial continuity.
LOWER EXTREMITY ANEURYSMS
Common Femoral Aneurysm
The common femoral artery (CFA) is a continuation of the external iliac artery as it ...