Advice and Information
by Dr Panayiotopoulos, Consultant Vascular and General Surgeon
1. What is a femoral aneurysm?
aneurysm is an abnormal dilatation [swelling] of an artery.
Aneurysms are not uncommon and affect mostly men after the age of 65
years. The commonest artery to be affected is the aorta [the main
artery in your stomach] followed by the popliteal and the femoral
artery. The latter is the artery in your groin that conveys
blood to your thigh and leg. If you have an aneurysm of one femoral
artery, in 40-60% of the cases the other leg has an aneurysm as
present with an aneurysm of your aorta, then the femoral and
popliteal arteries should be examined to confirm or exclude the
presence of an aneurysm. The opposite is also true [scan of the
aorta in the presence of popliteal or femoral aneurysm 50%].
is a false femoral aneurysm?
This is an
aneurysm of the artery that develops following arterial surgery in
the groin or trauma or even puncture in the artery from a
cardiologist or radiologist. It develops only in a small of cases.
It is different from the one described previously as it represents a
cavity outside the artery with blood circulating into it.
3. How is
30% it is found incidentally during In about 60% of patients the
diagnosis is made by the patient or the doctor who some
investigation, while in 10% it may present acutely with symptoms.
diagnosis is confirmed by ultrasound and then angiography [x-ray of
the arteries] if surgery is contemplated.
is the danger from a femoral aneurysm?
The main risks are:
that will occlude the lumen and
into smaller arteries in the leg or foot.
risk is about 10-25%, and depends as well on the size of the
aneurysm. False aneurysms are more likely to cause complications and
should be corrected surgically whenever discovered. For true femoral
aneurysms surgery is indicated in complications or when the diameter
of the aneurysm is more than twice the diameter of the normal artery
is the best treatment?
is the best treatment available!
However, thrombolysis via an arterial catheter may be useful
in acute stages. Only rarely an endovascular procedure [stent graft
insertion] performed in radiology is feasible.
Surgery should be
In all symptomatic femoral aneurysms
In all aneurysms greater than 3cm in diameter
[symptomatic or asymptomatic].
In all false femoral aneurysms.
there any tests needed before surgery?
In most of
the cases an ultrasound and an angiogram are the only tests needed.
Of course, If you are not already in the hospital you will be asked
to attend a pre-admission clinic about a week before the
operation in order to allow time for tests required to make sure you
are fit for the operation. An x-ray of the arteries [arteriogram]
to find where the blockages are may be performed if it has not
already been done.
is a popliteal aneurysm?
An aneurysm is an abnormal dilatation
[swelling] of an artery. Aneurysms are not uncommon and affect
mostly men after the age of 65 years. The commonest artery to be
affected is the aorta [the main artery in your stomach] followed by
the popliteal artery. The latter is the artery behind your
knee that conveys blood to the leg and foot. If you have an aneurysm
of one popliteal artery, in 60-70% of the cases the other leg has an
aneurysm as well.
If you present with an
aneurysm of your aorta, then the popliteal arteries should be
examined to confirm or exclude popliteal aneurysm. The opposite is
also true [scan of the aorta in the presence of popliteal aneurysm
is it diagnosed?
In about 60% of patients
the diagnosis is made only when symptoms appear.
In the rest it is
found incidentally [ a pulsatile mass behind the knee] and the
diagnosis is confirmed by Ultrasound and then angiography [x-ray of
3. What is the danger
from a popliteal aneurysm?
As about two thirds to
half of the popliteal aneurysms will present with serious
complications, it is necessary to diagnose them early.
1. Rest pain due to
thrombosis [blockage] of the arteries, threatening your limb [15%]
of your leg [8%]
and venous insufficiency due to compression of the popliteal vein
Foot drop and
other neurological symptoms due to nerve compression [5%]
Rupture of the
In acute symptomatic
cases, despite surgery, the foot is salvaged in 60-70% only.
What is the best treatment?
the only treatment available! However, throbolysis via an arterial
catheter may be useful in acute stages.
should be performed:
In all symptomatic popliteal aneurysms
In all aneurysms greater than 2cm in diameter [symptomatic or
Your Leg Aneurysm Operation
Coming into hospital
Please bring with you
all the medications that you are currently taking. You will be
admitted to your bed by one of the nurses who will also note down
your personal details in your nursing records. Prior to surgery you
will undergo a number of investigations, if these have not been
performed previously, including a heart tracing, a chest x-ray and
blood tests. You will be visited by the surgical team who will
perform your operation as well as the doctor who will give you the
anaesthetic. If you have any questions regarding the operation
please ask the doctors. You will be started on injections of heparin
which will continue throughout your stay in hospital. This stops
blood clots forming in the veins of your legs.
The aim is
firstly, to excise the aneurysm secondly to reestablish blood flow
to your leg. You will be taken into the anaesthetic room and from
there to theatres. You will either be put to sleep [a general
anaesthetic] or you will have a small tube placed in your back [epidural]
which can make numb the lower part of your body and helps with pain
relief following surgery, by injecting pain killers through it.
Sometimes you will have this as well as general anaesthetic in order
to provide pain relief after surgery. Whilst you are asleep, tubes
will also be inserted into your bladder to drain your urine and into
a vein in your arm or neck or both for blood pressure measurements
and administration of fluids following surgery.
Through a vertical incision in your groin the aneurysm is prepared and
dissected free till normal artery is found above and below it. Blood
flow is then stopped, the aneurysm is opened and is replaced by
plastic tube graft.
are closed with a stitch under the skin that dissolves by itself.
The type of surgery varies,
but the aim is, firstly, to exclude the aneurysm by tying it at both
its ends and secondly to perform some type of bypass to bring blood
to your leg below the aneurysm. If the aneurysm is big and
compresses the vein or the nerve, it will have to be excised. The
surgeon will inform you about the procedure he plans to perform
before you are taken to theatres.
You will be
taken into the anaesthetic room and from there to theatres. You will
either be put to sleep [a general anaesthetic] or you will
have a small tube placed in your back [epidural] which can
make numb the lower part of your body and helps with pain relief
following surgery, by injecting pain killers through it. Sometimes
you will have this as well as general anaesthetic in order to
provide pain relief after surgery. Whilst you are asleep, tubes will
also be inserted into your bladder to drain your urine and into a
vein in your arm or neck or both for blood pressure measurements and
administration of fluids following surgery.
Bypass using your vein. The
bypass will be usually performed by using your own leg vein
[donít worry, you can manage without it].
this technique the aneurysm is approached from behind your knee with
an S-shaped incision.
This procedure is
accompanied by less morbidity, has the advantage of excising the
aneurysm [in compression symptoms] but the result is slightly worse
to the bypass if we look at the time the graft runs without
are closed with a stitch under the skin that dissolves by itself.
operation you will be given all the fluids you require in a drip
in one of your veins until you are well enough to sit up and take
fluids and food by mouth. Most patients sit out in a chair on the
first day after surgery and you will be encouraged to walk the
and doctors will try and keep you free of pain by giving pain
killers by injection via the tube in your back or by a machine that
you are able to control by pressing a button.
As the days
pass and you improve the various tubes will be removed and
you will become gradually more mobile until you are fit enough to go
home. This is usually 7-14 days after your operation. You
will be visited by the physiotherapist before and after the
operation who will help you with your walking and with your
breathing to prevent you developing a chest infection.
As dissolvable stitches have been used, these do not
need to be removed. However, the stitch takes a long time to
dissolve and if it comes to the surface it may be removed with a
You will feel tired for many weeks after the operation
but this should gradually improve as time goes by. Regular exercise
such as short walk combined with periods of rest is recommended for
the first few weeks after surgery, followed by a gradual return
to your normal activity.
You will be safe to drive when you are able to move without pain and
perform an emergency car stop.
You may bathe or shower as normal, but do not soak in a bath until
the wound is fully healed [i.e. no scabs as these may become soggy]
You should be able to return to work within 1-3 months following
your operation. If in doubt, please ask your doctor.
You will usually be sent home on a small dose of aspirin if
you were not already taking it. This is to make the blood less
sticky. If you are unable to tolerate aspirin an alternative drug
may be prescribed. You should also continue taking your regular
You may resume sexual activity when you feel comfortable to do so.
The main acute complication with this sort of surgery is
embolisation downstream from debri inside the aneurysm
[1-2%]. In such a case the surgeon may have to perform further
surgery to re-establish blood flow to the rest of your leg.
Slight discomfort and twinges of pain in your wound is normal
for several weeks following surgery, but wounds sometimes become
infected and these can usually be successfully treated with
antibiotics. Also the wound in your groin may fill with a fluid
called lymph that may discharge between the stitches, but
this usually settles down with time. If you had a long cut down your
leg to harvest your leg vein, this wound may be red and swollen for
7-14 days and some fluid may ooze from it.
You may have patches of numbness around the wound or
lower down the leg which is due to cutting small nerves to the skin.
This can be permanent but usually gets better within a few months.
It is also common for the foot to swell due to
improved blood supply. You must sit with your leg higher than your
bottom until the swelling goes.
A late complication [5%] is
blood clotting within the graft causing it to block,
and if this occurs it will usually be necessary to perform
another operation or a special x-ray procedure [thrombolysis]
to clear the graft.
What is the success rate?
rate is excellent for non-symptomatic and symptomatic aneurysms
without limb ischaemia.
As in all
bypasses the results depend on the condition of the rest of your
remain open in a year and 80-90% in 3-5 years. The risk of surgery
is small [2-4%] depending on your overall medical condition.
The risk of
amputation is about 1%.
Your vascular Surgeon will see
you in the outpatients clinic 6 weeks after discharge. As these
types of grafts do not last for ever, you will be entered into a
surveillance program and a painless ultrasound scan of the graft
will be performed after 3 months, then 6 months and after this at 6
or 12 monthly intervals. Thus we can detect early narrowings of the
graft and proceed to angioplasty [ballooning of the narrowing in
x-ray department] if there is a need to do so, extending thus graft
performed in outpatients
both the operated groin and
the distal arteries in your
The remaining of the
arteries in your leg are also checked by the ultrasound in order to
discover early narrowings [blockages] that have not yet caused you
What can I do to help myself?
If you were
previously a smoker you must make a sincere and determined effort to
stop completely. Continued smoking will cause further damage to your
arteries and your graft is more likely to stop working.
health measures such as reducing weight, a low fat diet and regular
exercise are also important.
IF YOU DEVELOP ANY SEVERE PAIN IN THE
LEG THE GRAFT MAY BE BLOCKED; THE SOONER YOU GET BACK TO THE
HOSPITAL THE EASIER IT IS FOR IT TO BE UNBLOCKED.
Please ring the Ward on
The vascular lab on 01245-514145
The Consultantís secretary on
01245-514095[NHS] or 01245-443379[Private]
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A written referral from a general practitioner is helpful but is not essentially required in order to make an appointment to see a consultant specialist.