Editing Lower limb aneurysms

* Frequently a/w aortic aneurysm

== Popliteal aneurysms ==

* Majority are true
* Definition
** 1.5-2cm popliteal artery external diameter
* Risk factors
** Almost all in men
** Smoking
** HTN
** CAD
* Presentations
** Incidental finding
** Pulsatile mass
** Acute limb ischaemia (thrombosis or embolism)
** Chronic claudication or blue toe syndrome
* Natural history
** 30% will develop thromboembolism by three years
* Examination
** Unreliable
* Imaging
** Duplex USS first-line
** Intra-arterial arteriography is gold-standard
* Intervention
** 2cm or greater in diameter
** Any symptomatic
* Surgical bypass
** Proximal and distal ligation
** Bypass with saphenous vein graft
** Thrombectomy or tPA may be required in emergent situation if no suitable outflow vessel
* Endovascular stent graft
** Identical indications
** Long-term results are unknown
** Generally reserved for high-risk patients

== Femoral aneurysms ==

* Many false
** Infected femoral pseudoaneurysm
*** Most commonly secondary to inadvertent intra-arterial injection of ilicit drugs
*** Tender, pulsatile groin mass, cellulitis, open draining punctate skin lesion, signs of systemic infection, sequelae of arterial embolisation or occlusion
*** Generally treated by ligating femoral artery and debriding
* True aneurysms (arteriosclerotic)
** Commonly a/w aneurysms in other locations (60%)
** Most commonly found in CFA
** Pathogenesis probably relates to inflammation and atherosclerotic degeneration of arterial wall
** Presentation
*** Pulsatile mass
*** Compressive symptoms - oedema and neuropathy
*** Commonly asymptomatic
*** Complications less commonly seen than with popliteal
** Diagnosis
*** Duplex USS
*** CTA is good
** Repair
*** >3cm
*** Symptomatic
*** Complicated
*** Rapidly-enlarging
*** Emergent repair in acute limb ischaemia due to thromboembolism/rupture
** Surgical repair
*** Ligation of inflow and outflow
*** Placement of dacron graft from external iliac to distal CFA
** Endovascular repair
*** Not currently recommended - frequent hip flexion risks stent fracture
* Pseudoaneurysms after arterial access
** Natural history is unclear, but the vast majority probably close on their own
** Up to a third will require repair
** Small uncomplicated pseudoaneurysms can be followed with serial USS
** >3cm or symptomatic should have treatment
*** USS guided compression or thrombin injection
*** Open surgical repair if these are failed
***

[[Category:Vascular]]