title: Surgical management of isolated superficial femoral artery degenerative aneurysms.
abstract: OBJECTIVE
  To investigate the mode of presentation, diagnosis, association with other aneurysms, operative management, and outcomes of superficial femoral artery (SFA) aneurysms.
  
  
  METHODS
  Records of all patients who underwent surgery for isolated, true SFA aneurysms (not due to infection, vasculitis, or tissue disorders) from 2002 to 2012 in two European centers were retrospectively analyzed. Demographic (sex, age), clinical (cardiovascular risk factors, location of the aneurysm, symptoms, presentation, emergency setting), surgical and radiological data (diameter, surgical technique, runoff vessels patency, presence of aneurysms elsewhere) were obtained for analysis. Follow-up was undertaken with clinical and ultrasound examinations at 1 month, 3 months, 6 months, 12 months, and yearly thereafter. The patency of the graft and the status of the anastomoses and inflow and outflow vessels were assessed. Main end points were represented by 30 days and long-term mortality and amputation-free survival.
  
  
  RESULTS
  A total of 27 cases of SFA aneurysm were analyzed. Mean age at operation was 78 years ± 8.5. At presentation, SFA aneurysms were often symptomatic (rupture was present in 7/27 cases and acute distal ischemia in 6/27 cases), large (mean diameter, 54 mm ± 33.1 mm), bilateral (38% of the cases), and associated with aneurysms elsewhere (84%). Sixteen patients underwent resection of the aneurysm and polytetrafluoroethylene interposition graft, seven patients exclusion of the aneurysm with a femoropopliteal bypass (autogenous bypass in five cases, prosthetic in two), three patients simple ligation, and one patient underwent primary amputation. Mean follow-up was 41.47 months (range, 0.43-128.67 months). Early (<30 days) mortality and amputation rate were 4% and 7%, respectively. Estimated 5-year survival, limb salvage, and graft patency rates were 62%, 88%, and 85%, respectively.
  
  
  CONCLUSIONS
  Degenerative aneurysms of the SFA display peculiar characteristics (in terms of clinical onset, diagnostic timing, and clinical behavior) so that they differ from other peripheral aneurysms. In fact, they often grow to reach a considerable diameter before medical attention is sought, presenting with rupture or ischemia at diagnosis. SFA aneurysms preferentially affect elderly men and are often associated with aneurysms elsewhere. However, despite their rarity, the treatment is usually feasible, and long-term outcomes are good.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University Hospital of Parma, Parma, Italy; Division of Vascular Surgery, Graduate School of Medicine, University of Nice-Sophia-Antipolis, Nice, France. Electronic address: p.perini@live.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Perini
authors.affiliation: Division of Vascular Surgery, Graduate School of Medicine, University of Nice-Sophia-Antipolis, Nice, France.
authors.forename: Elixene
authors.initials: E
authors.lastname: Jean-Baptiste
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Vezzosi
authors.affiliation: Division of Vascular Surgery, Graduate School of Medicine, University of Nice-Sophia-Antipolis, Nice, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Raynier
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mottini
authors.affiliation: Division of Vascular Surgery, Graduate School of Medicine, University of Nice-Sophia-Antipolis, Nice, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Batt
authors.affiliation: Division of Vascular Surgery, Graduate School of Medicine, University of Nice-Sophia-Antipolis, Nice, France.
authors.forename: Réda
authors.initials: R
authors.lastname: Hassen-Khodja
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Pierfranco
authors.initials: P
authors.lastname: Salcuni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000783:Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005602:France; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008026:Ligation; D023821:Limb Salvage; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency