The current management of isolated degenerative femoral artery aneurysms is too aggressive for their natural history

Background Previous studies have combined anastomotic, catheter-induced, and atherosclerotic isolated femoral artery aneurysms (FAAs) to achieve adequate numbers for analysis and have recommended repair of asymptomatic FAAs with diameters ≥2.5 cm and all symptomatic FAAs. This study evaluated the contemporary management of isolated FAAs. Methods Patients with FAAs were evaluated using a standardized, prospectively maintained database by a research consortium. Results From 2002 to 2012, 236 FAAs were identified in 182 patients (mean age, 72 years; male-to-female ratio, 16:1) at eight institutions. The mean nonoperative mean diameter was 2.8 ± 0.7 cm, and the operative diameter was 3.3 ± 1.5 cm. FAA location was the common femoral artery in 191, superficial femoral artery (SFA) in 34, and profunda femoris artery in 11. Synchronous aneurysms (mean, 1.7 per patient) occurred in the aorta (n = 113), in the iliac (n = 109), popliteal (n = 86), and hypogastric (n = 56) arteries, and in the contralateral common femoral artery (n = 34), SFA (n = 9), and profunda femoris artery (n = 2). Of the aneurysms repaired, 66% were asymptomatic; other indications for repair were claudication (18%), local pain (8%), nerve compression (3%), rupture (2%), acute thrombosis (1%), and rest pain (0.5%). Acute aneurysm-related complications (rupture, thrombosis, embolus) were associated ( P < .05) with FAA diameter >4 cm and intraluminal thrombus, but not location. Mean diameter of asymptomatic aneurysms that developed acute complications was 5.7 ± 1.3 cm for rupture, 4 ± 1.1 cm for thrombosis, and 3.5 cm for embolus. Repair was by interposition or bypass graft in 177 FAAs and by endovascular repair in three SFA aneurysms. Two perioperative deaths, of myocardial infarction and multisystem organ failure, occurred at 30 days. Operative complications included wound infection (6%), seroma (3%), and bleeding (2%). No amputations occurred through 5 years in the operative or nonoperative groups. Survival in operated-on patients was 99% (n = 138) at 3 months, 92% at 1 year, and 81% (n = 20) at 5 years. Conclusions This largest study of isolated FAAs demonstrates that (1) acute complications did not occur in FAAs ≤3.5 cm, repair criteria of asymptomatic FAAs should be changed to >3.5 cm, and chronic intraluminal thrombus should reduce the threshold for repair, and that (2) current indications for symptomatic FAA repair result in low morbidity and should remain unchanged.