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Chapter 30: Peripheral Arterial Aneurysms

Ahmed A. Sorour; Levester Kirksey

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.

FIGURE 30-1

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.)

A 2-part illustration to compare the various types of aneurysms. "Part A: Normal aneurysm: A circular blood vessel has an outward or upward bulging and is indicated by a down arrow. True aneurysm: A circular blood vessel has abnormal dilation of the artery walls along the sides. False aneurysm or pseudo aneurysm: Abnormal outpouching is visible outside the blood vessel along the left side. This is indicated by a left arrow. A true aneurysm is classified into a fusiform aneurysm and a saccular aneurysm. Fusiform aneurysm: The flow of the blood is indicated by a down arrow in a normal blood vessel. But during a fusiform aneurysm, the blood vessel expands and the flow of blood spreads along the sides. This is indicated by the right and left arrows. Saccular aneurysm: A sac-like ballooning is visible in the side wall of an artery. Hence the flow of blood deviates from its normal direction. This is indicated by a curved left arrow. Part B: Schematic representations compare fusiform and saccular aneurysms. Fusiform aneurysm: An artery expands on its sides and hence the flow of blood spreads along the sides. Saccular aneurysm: A sac-like ballooning is visible in the side wall of an artery."
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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.

TABLE 30-1Etiology of Peripheral Artery Aneurysms
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TABLE 30-1 Etiology of Peripheral Artery Aneurysms

  • Atherosclerotic

  • Iatrogenic

  • Main etiology for false aneurysm

  • Mycotic

  • Bacterial, fungal, spirochetal

  • Inflammatory

  • Behçet’s disease, Parkes Weber syndrome, Granulomatosis with polyangiitis

  • Congenital

  • Ehlers-Danolas, Marfan’s syndrome

  • Traumatic

  • Blunt or penetrating trauma

  • Mechanical

  • Atriovenous fistula associated, poststenotic

Data from Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg. 1991;13(3):452-458.

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 ...

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