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Peripheral Arterial Aneurysms

By

Koon K. Teo

, MBBCh, PhD, McMaster University

Last full review/revision May 2021| Content last modified May 2021
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Peripheral arterial aneurysms are abnormal dilations of the peripheral arteries caused by weakening of the arterial wall.

Infectious (mycotic) aneurysms may occur in any artery but are most common in the femoral. They are usually due to salmonellae, staphylococci, or Treponema pallidum (which causes syphilitic aneurysm).

Peripheral arterial aneurysms are usually asymptomatic at the time of detection. Thrombosis or embolism (or rarely, aneurysm rupture) causes extremities to be painful, cold, pale, paresthetic, or pulseless. Infectious aneurysms may cause local pain, fever, malaise, and weight loss.

Diagnosis is by ultrasonography, magnetic resonance angiography, or CT. Popliteal aneurysms may be suspected when physical examination detects an enlarged, pulsatile artery; the diagnosis is confirmed by imaging tests.

Risk of rupture of extremity aneurysms is low (< 5% for popliteal and 1 to 14% for iliofemoral aneurysms). For leg artery aneurysms, surgical repair is therefore often elective. It is indicated when the arteries are twice normal size or when the patient is symptomatic. However, surgical repair is indicated for all arm artery aneurysms because serious complications (eg, thromboembolism) are a greater risk. The affected segment of artery is excised and replaced with a graft. Limb salvage rate after surgical repair is 90 to 98% for asymptomatic patients and 70 to 80% for symptomatic patients.

In certain patients, an endovascular stent graft is another option for repair.

Key Points

  • Peripheral arterial aneurysms occur mainly in men; the most common location is the popliteal artery.

  • Complications are rare and include rupture and thromboembolism.

  • Treat lower extremity aneurysms if patients are symptomatic or if the artery is twice normal size; all upper extremity aneurysms should be treated because of the higher risk of serious complications (eg, stroke).

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