Less invasive (common) femoral artery aneurysm repair using endografts and limited dissection

Objective: We report our experience with the treatment of femoral artery aneurysms (FAAs) under localanaesthesia with limited dissection, using endografts to facilitate the proximal anastomosis and some distalanastomoses.Method: Between January 2006 and December 2010, six males, mean age 72 years (range, 65e80 years) withFAAs were treated at the University Hospital of Zurich. All operations were performed under local anaesthesiawith analgosedation, except for one performed under spinal anaesthesia. After limited dissection and puncture ofthe anterior wall of the FAA, a sheath and a self-expanding endograft were introduced over a guide wire and withfluoroscopy they were guided intraluminally into the proximal normal neck of the FAA and deployed. Proximalarterial control was achieved with a balloon catheter introduced through the endograft. Then the FAAs wereopened and distal arterial control is obtained with balloon catheters. The distal end of the stent graft was thensutured to the normal-sized distal arteries or to stent grafts placed within them.Results: Of the six FAAs, four were true and two were false anastomotic aneurysms. Mean FAA diameter was5.0 cm (range, 3.0e6.5 cm). Four patients also had aneurysmal involvement of the external iliac artery, onepatient also had deep femoral aneurysms, but deep femoral circulation was always preserved. In three of thepatients, the distal anastomosis was created to the femoral artery bifurcation, in two patients to the deepfemoral artery when the superficial femoral artery (SFA) was chronically occluded and in one patient to the SFA.Immediate technical success was achieved in all six patients, and graft patency was observed from 9 to 48months (mean 29 months). There were no amputations, complications or deaths.Conclusion: This technique for repair of FAAs can be performed under local anaesthesia, minimises dissection andcomplications and simplifies exclusion of these lesions. It is of particular value in high-risk patients with large FAAs.