Femoral aneurysm
Introduction
Introduction to femoral aneurysms The incidence of femoral aneurysms (femoralaneurysm) accounts for more than half of the peripheral aneurysms in China, ranking first. There are two types of true aneurysms and pseudo-arteries. The former occurs mostly in patients with atherosclerosis, often with aneurysms in other parts of the body. The latter is common after trauma and infection. Clinically, the acute ischemia of the distal limb can be caused by thrombosis or thrombus in the aneurysm, which can cause amputation of the distal limb. Therefore, active surgical treatment is very important. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: thrombosis
Cause
Femoral aneurysm
(1) Causes of the disease
Trauma (35%):
A stab wound or a bullet wound in the thigh can cause the vessel wall to rupture or completely break. First, it forms a limitation in the surrounding soft tissue. The pulsatile hematoma is gradually surrounded by the proliferating fibrous tissue. The blood clot is liquefied and absorbed to form a pseudo. Aneurysm; blunt contusion, crush injury and other indirect trauma can damage the arterial membrane, elastic fiber breaks, the wall is weak, gradually expand under pressure to form an aneurysm, and patients with traumatic femoral aneurysm are younger. , between the ages of 20 and 40, are pseudoaneurysms.
Atherosclerosis (20%):
It is the most common cause in Europe and the United States. Patients are over 50 years old, often accompanied by hypertension, coronary heart disease or multiple aneurysms, atherosclerotic arterial wall intimal thickening, nourishing vascular compression and tube wall dystrophies The elastic fiber layer is broken, calcified, etc., which causes some of the wall to degenerate, weak and bulge to form an aneurysm, which is generally a true aneurysm.
Infection (15%):
Endogenous infections such as sepsis, respiratory infections, bacterial endocarditis or perivascular local purulent infections, and open wounds, iatrogenic infections and other exogenous pathways can nourish blood vessels Or a small abscess in the blood vessel wall, causing the arterial membrane to become weak, and the infectious aneurysm is easy to rupture. In recent years, the wound has gradually become the main cause of infectious femoral aneurysm.
Iatrogenic factors (12%):
With the extensive development of interventional therapy, the report of arterial intubation injury to the formation of pseudo-femoral aneurysms has gradually increased. In addition, the number of revascularization operations has increased, due to local hematoma of the anastomosis, infection or anastomosis techniques, etc. The weak, fractured and gradually formed anastomotic pseudoaneurysm also has an increasing trend.
Other reasons (8%):
Such as degenerative degeneration of the arterial membrane, congenital arterial defects (such as Marfan syndrome) can also cause femoral aneurysms, but less common.
(two) pathogenesis
Femoral aneurysms mainly occur in the femoral triangle, above the common femoral artery. It is rare to involve the common femoral artery from the external aneurysm. Single-onset femoral and deep femoral aneurysms are sometimes reported, but rare, there are also femoral artery branches. Report of the lateral femoral aneurysm, the true aneurysm is mostly rhomboid, and the pseudoaneurysm caused by the injury is mostly spherical.
According to the invasive part of the aneurysm, Cutler et al. classify the femoral aneurysm into type 2, the tumor is confined to the common femoral artery and is called type I. The tumor extends to the deep femoral artery and is called type II. The incidence of type 2 is about equal.
In patients with atherosclerotic aneurysms, men are more common, often over 50 years old, often accompanied by hypertension and other areas of atherosclerotic disease, so this aneurysm is often not isolated, 95% have 2 aneurysms, 92% had radial aneurysms, 59% were bilateral, and patients with traumatic femoral aneurysms were younger, 20 to 40 years old, mostly pseudoaneurysms, and femoral artery induced by femoral artery puncture. The probability of pseudoaneurysm is about 1%. The main common femoral artery and femoral-iliac artery bypass grafting need to use the femoral artery as the inflow and outflow tract. Once the anastomosis leaks, it can be formed locally. Pseudoaneurysm, the incidence of anastomotic aneurysm of the femoral artery caused by these two bypass surgery is 1.5% to 3%, and the main-femoral artery bypass is more likely to cause anastomotic aneurysm than the femoral-iliac artery bypass. Both aneurysms and iliac aneurysms can cause acute ischemia of the distal limb due to thrombosis within the aneurysm or shedding of the distal artery.
Prevention
Femoral aneurysm prevention
In the usual life, you should eat some soy products, do not eat some high-fat, high-sugar, high-salt diet. People need to be particularly peaceful, not to lose their temper, the more tempered, the easier it is to get cardiovascular disease. To have a good attitude, peace, many people are looking at something very light. Also eat more fruits and eat less salt. For example, vegetables and fruits rich in vitamins, eat more fish, fish can help relax the arteries or dilute the blood, eat more this is ok. Usually proper exercise, smoking and drinking have an arousal effect on aortic aneurysm. Red wine we advocate a cup of drink a day, and more will be counterproductive.
Complication
Femoral aneurysm complications Complications thrombosis
1. Thrombosis or shedding of the distal artery in a limb ischemic aneurysm can cause acute ischemia and necrosis of the distal limb.
2. Femoral aneurysm rupture due to the protection of muscles and fascia around the femoral aneurysm, rupture bleeding is rare, a large hematoma is formed in the thigh when bleeding occurs, and the distal pulsation of the artery is weakened.
Symptom
Symptoms of femoral aneurysm Common symptoms Radioactive pain Persistent pain Joint swelling and pain Pain varicose veins Intermittent cyanosis Thrombosis Lower extremity Superficial varicose veins Lower extremity chills
A pulsatile mass with progressive enlargement of the medial thigh is the most common symptom of the disease. It is generally painless or has mild pain or tenderness. Infectious aneurysms may have persistent pain. The tumor may be numb with compression of the femoral nerve. , radiation pain. Compression of the femoral vein may have superficial varicose veins of the lower extremities, swelling of the ankle joint, limited joint activity in severe cases, thrombosis or distal embolization, limbs may have ischemic symptoms, manifested as coldness of the lower extremities, intermittent claudication or rest pain, Patients with infectious femoral aneurysms can have systemic infections at the same time: fever, physical discomfort, weight loss, elevated white blood cells, aerobic or anaerobic bacteria in the blood, and accelerated erythrocyte sedimentation rate.
Examine
Femoral aneurysm examination
Increased white blood cell count, accelerated erythrocyte sedimentation rate and positive blood culture bacteria suggest an infectious aneurysm.
1. Ultrasound examination Bifunctional ultrasound can clearly show the morphology, structure, size and intracavitary thrombosis of an aneurysm, and can understand the hemodynamic information such as flow rate and flow rate, and can be used to distinguish diseases such as arteriosclerosis obliterans. In addition, with its non-invasive nature, it can be used to screen for aneurysms that are combined with other sites.
2. CT scan is helpful for diagnosis, can show the size of aneurysm, whether there is calcification and wall thrombus in the tumor wall, and the liquid or gas around the infectious aneurysm, and can be differentiated from non-vascular tumors.
3. MRI examination without the need for contrast agents can show the size, extent, intracavitary thrombosis, clear display of the various layers of the arterial wall, identification of true, pseudoaneurysm.
4. Arteriography is the most important means to determine the diagnosis and development of surgical plans. It can accurately understand the aneurysm and peripheral blood vessels, especially the patency of the inflow and outflow tracts. The choice of aneurysm resection and revascularization has Guiding significance, in addition, can also help to find aneurysms in other areas.
Diagnosis
Diagnosis and diagnosis of femoral aneurysm
diagnosis
1. Patients with medical history have manifestations of arteriosclerosis of the body, or a history of local injury, puncture cannula or surgical history.
2. Clinical manifestations of the inside of the thigh, especially the expansive pulsatile mass of the femoral triangle, combined with oppression and limb ischemic symptoms and signs, suspected of this disease.
3. Auxiliary examination of ultrasound Doppler, CT, angiography and other examinations can help to confirm the diagnosis.
Differential diagnosis
For patients with aneurysm thrombosis, the aneurysm boundary and pulsation are not obvious when it is differentiated from other tumors in the thigh.
