Femoral Artery Aneurysm: Symptoms, Types, Causes and Treatment

Femoral artery aneurysm (FAA) is a rare but potentially serious vascular condition that requires timely recognition and management. While less common than aneurysms in other locations, such as the aorta or popliteal artery, femoral artery aneurysms can lead to limb-threatening and sometimes life-threatening complications if not identified and treated appropriately. This article provides a comprehensive overview of the symptoms, types, causes, and treatment options for femoral artery aneurysms, synthesizing the latest research and clinical findings.

Symptoms of Femoral Artery Aneurysm

Femoral artery aneurysms are notorious for presenting with subtle or nonspecific symptoms, often masquerading as more common conditions. Recognizing the signs and symptoms is crucial for early diagnosis and intervention, which can dramatically reduce the risk of complications.

Presentation	Frequency/Details	Complications	Sources
Pulsatile mass	Common, often in groin or thigh	Can mimic hernia	1 2 9
Local pain	Frequent	Nerve compression	1 9
Distal ischemia	Up to 46%	Thrombosis, emboli	2 4 5
Rupture	10–35% (rarer, but severe)	Hemorrhage, limb loss	1 4 5 6
Edema	Large aneurysms	Venous congestion	9
Asymptomatic	Detected incidentally	Risk of sudden events	2 9 11

Table 1: Key Symptoms

Understanding the Symptom Spectrum

The clinical manifestations of femoral artery aneurysms depend on the size, location, and whether complications like thrombosis or rupture occur.

Pulsatile Mass and Pain

• Pulsatile mass in the groin or thigh is the most classic sign. It is often mistaken for a hernia but can be distinguished by its pulsation on physical exam. Localized pain may occur, especially as the aneurysm enlarges and presses on nerves or surrounding tissues 1 9.
• Pain can be dull or sharp and may worsen with activity or when the aneurysm compresses adjacent nerves 1.

Distal Ischemia

• Symptoms such as sudden leg pain, coldness, numbness, or color changes can indicate distal ischemia due to embolism or thrombosis. This presentation is seen in up to 46% of cases and carries a risk of limb loss if not managed promptly 2 4 5.

Rupture

• While less frequent (10–35%), a ruptured femoral artery aneurysm is a surgical emergency, often presenting as severe pain, rapidly enlarging mass, and signs of hemorrhagic shock 1 4 5 6.

Edema and Venous Issues

• Large aneurysms may compress nearby veins, leading to swelling (edema) in the affected leg, and in rare cases, deep vein thrombosis 9.

Asymptomatic Cases

• Some aneurysms are discovered incidentally during imaging for other reasons or during physical examination, especially in patients being evaluated for other aneurysms 2 9 11.

Types of Femoral Artery Aneurysm

Femoral artery aneurysms are not a single entity; they can be classified by their anatomical location and underlying pathology. Understanding the types helps guide diagnosis and management.

Type	Definition/Location	Key Features	Sources
True aneurysm	Involves all vessel layers	Often atherosclerotic	3 5 9 13
False aneurysm	Breach in vessel wall, not all layers	Post-trauma/catheterization	3 7 8 9 12
Common femoral	At femoral artery bifurcation	Most frequent type	5 11
Superficial femoral	Middle thigh artery section	Rare, deep location	1 2 4 6
Profunda femoris	Deep thigh artery	Very rare	5 7 11

Table 2: Types of Femoral Artery Aneurysm

Breaking Down the Types

True vs. False Aneurysms

• True aneurysms involve dilation of all three layers of the vessel wall (intima, media, adventitia). They are most often associated with atherosclerosis and predominantly affect elderly men. True femoral aneurysms are often bilateral and may coexist with aneurysms in other arterial beds 3 5 9 13.
• False aneurysms (pseudoaneurysms) occur when a breach in the artery wall leads to blood collecting outside the vessel layers, often contained by surrounding tissue. These are commonly linked to trauma, catheterization, surgical procedures, or infection 3 7 8 9 12.

Anatomical Subtypes

• Common femoral artery aneurysms are the most frequently encountered, located at the bifurcation in the groin 5 11.
• Superficial femoral artery (SFA) aneurysms occur in the middle segment of the thigh. These are rare and often reach a large size before detection due to their deep location 1 2 4 6.
• Profunda femoris aneurysms are even rarer. They may result from trauma or iatrogenic causes (e.g., orthopedic hardware), and their diagnosis can be delayed 5 7 11.

Special Considerations

• Bilateral aneurysms and synchronous aneurysms in other sites (aorta, popliteal, iliac arteries) are common, especially in patients with true aneurysms 9 11 13.
• Classification systems such as the Cutler and Darling classification (Type 1 and 2) describe the relationship to the femoral bifurcation, though this is more relevant in surgical planning 5.

Causes of Femoral Artery Aneurysm

The development of femoral artery aneurysms is multifactorial. Understanding the underlying causes is critical for both prevention and tailored management.

Cause	Description	Common in	Sources
Atherosclerosis	Degeneration of vessel wall due to fatty deposits	Elderly men	1 3 4 5 9 13
Trauma	Direct injury, fractures, or surgery	All ages	7 8 9
Iatrogenic (catheterization)	Post-angiography or intervention	Hospitalized	8 9 12
Connective tissue disorders	E.g., Marfan, Ehlers-Danlos	Rare	9
Infection (mycotic)	Bacterial/fungal infection of the arterial wall	Immunocompromised	9 10
Inflammatory (vasculitis)	Diseases like Behçet disease	Young adults	10
Hypertension & Smoking	Risk factors for atherosclerosis	Older adults	9

Table 3: Causes of Femoral Artery Aneurysm

Delving into the Causes

Atherosclerosis

• Atherosclerosis is the most common cause of true femoral artery aneurysms. The process involves degeneration and weakening of the arterial wall from chronic plaque buildup, leading to dilation. Most patients are elderly, male, and have a history of smoking or high blood pressure 1 3 4 5 9 13.

Trauma and Iatrogenic Injury

• Trauma—including fractures or orthopedic procedures—can cause pseudoaneurysms, especially if hardware like screws injure the artery 7.
• Iatrogenic causes are increasingly common, particularly following catheterization for cardiac or vascular procedures. The rise in interventional radiology has led to a higher incidence of femoral pseudoaneurysms 8 9 12.

Other Medical Conditions

• Connective tissue disorders such as Marfan or Ehlers-Danlos syndromes predispose to aneurysm formation due to inherent wall weakness, though these are rare in the femoral artery 9.
• Infectious (mycotic) aneurysms may develop in the setting of bacteremia or endocarditis, especially in immunocompromised or intravenous drug users 9 10.
• Inflammatory diseases like Behçet disease can rarely cause femoral aneurysms through vasculitis and vessel wall destruction 10.

Risk Factors

• Smoking and hypertension are modifiable risk factors that contribute to the development and progression of atherosclerotic aneurysms in the femoral artery 9.
• Male gender and advanced age are non-modifiable risk factors, with most cases occurring in men over 70 years 1 3 5 9 13.

Treatment of Femoral Artery Aneurysm

Treatment strategies for femoral artery aneurysms depend on the type, size, symptoms, and presence of complications. Prompt intervention is vital to prevent limb loss or death.

Approach	Indication	Method	Sources
Observation	Small, asymptomatic, <3–3.5cm	Serial imaging, monitoring	3 11
Open surgical repair	Symptomatic, >3.5cm, complicated	Interposition or bypass graft	1 2 3 4 5 9 11 13
Endovascular repair	Select cases, SFA aneurysm	Stent graft	1 9 11
Thrombin injection	Pseudoaneurysm (<3cm), non-infected	Ultrasound-guided thrombin	3 8 12
Compression therapy	Small pseudoaneurysm	Ultrasound-guided manual pressure	3 12
Emergency surgery	Rupture, infection, failed minimally invasive	Open ligation/graft	4 6 7 9 10

Table 4: Treatment Options

Treatment Modalities Explained

Observation and Surveillance

• Small (<3–3.5 cm), asymptomatic true aneurysms may be monitored with regular imaging, as the risk of acute complications is low below this size threshold 3 11.
• Criteria for intervention have shifted from repair at 2.5cm to >3.5cm for asymptomatic aneurysms, unless rapid growth, thrombus, or other risk factors are present 11.

Open Surgical Repair

• Open surgery is the gold standard for symptomatic, large, or complicated aneurysms. It typically involves excision of the aneurysm with placement of an interposition or bypass graft, often using synthetic materials or saphenous vein 1 2 3 4 5 9 11 13.
• Emergency surgery is indicated for rupture or acute limb ischemia and may involve ligation if revascularization is not feasible 4 6 7 9 10.
• Perioperative outcomes are generally favorable, with high limb salvage rates and low operative mortality in experienced centers 2 4 13.

Endovascular Repair

• Endovascular techniques (stent graft placement) are increasingly used in select cases, particularly for superficial femoral artery aneurysms. However, data are limited and long-term outcomes are still being studied 1 9 11.

Management of Pseudoaneurysms

• Ultrasound-guided thrombin injection is the first-line therapy for most femoral pseudoaneurysms, offering a minimally invasive, highly effective solution with rapid recovery 3 8 12.
• Ultrasound-guided compression is an alternative, especially when thrombin is contraindicated 3 12.
• Surgical repair is reserved for infected, rapidly expanding, or failed minimally invasive cases 3 7 9.

Special Considerations

• Associated aneurysms: Because femoral aneurysms often coexist with aortic or popliteal aneurysms, a full vascular assessment is essential before surgery 2 3 9 11 13.
• Inflammatory or mycotic aneurysms: These require both surgical and medical management, including infection control and, where relevant, immunosuppression 9 10.

Conclusion

Femoral artery aneurysms, though rare, represent a critical vascular condition that can present with a variety of symptoms or remain silent until severe complications arise. Understanding their types, causes, and modern management strategies is essential for optimal outcomes.

Key takeaways:

• Symptoms range from a palpable pulsatile mass and local pain to limb-threatening ischemia and, rarely, rupture. Many cases are discovered incidentally.
• Types include true (atherosclerotic) and false (pseudoaneurysm), with further classification by anatomical location.
• Causes are multifactorial, with atherosclerosis, trauma, and iatrogenic injury being most common.
• Treatment is tailored to aneurysm size, symptoms, and type—ranging from observation to advanced endovascular or open surgical techniques, with high success rates in specialized centers.

Early recognition and coordinated care are vital for preventing complications and ensuring the best possible prognosis for patients with femoral artery aneurysms.