Discussion

Dr Amy Reed (Cincinnati, Ohio): I’d just like to make a special comment and congratulate you on the presentation. Dr Harbuzariu is a general surgery resident interested in vascular surgery, and I applaud you for a great presentation. Certainly, this is probably one of the larger series of profunda femoral artery aneurysms that’s been brought to our attention, and I’m sure that most of us in the room do not encounter this entity on a monthly, yearly, or if ever, basis. So, I just have a few questions: First, what was the size of the Dacron graft that you used and why did you choose that versus an autogenous conduit? Second, in the manuscript, you commented on the patient that underwent a successful percutaneous embolization 2 years after endoaneurysmorrhaphy. Given that your operative time was over 5 hours and a 700 mL blood loss, in retrospect would there be any endovascular options, particularly in patients who have had prior incisions in their groin?

Dr Harbuzariu: Regarding the size of the graft, all the synthetic grafts we used were No. 8 Dacron grafts, and the main reason for this was to match the size of the arteries in those specific repairs. In just one patient a vein graft was used, and that was the patient who had an infected aneurysm. Regarding the potential use of endovascular repair for this, I think it is a potential good solution for patients whose aneurysms are located in the distal part of the profunda femoris artery or its branches, where an endovascular approach would not compromise the collateral blood flow to the lower extremity, especially if those patients have a patent ipsilateral superficial femoral artery.

Dr Ruth Bush (Temple, Tex): I have a question for you. You had 11 patients that were asymptomatic and also 11 patients were found to have synchronous aneurysms, making the assumption that these perhaps were the same groups; otherwise, it will be very difficult to find an asymptomatic profunda femoris artery aneurysm. Tell me a bit about planning the operation in the asymptomatic patients who had synchronous aneurysms: Were these performed as staged procedures perhaps with the concomitant popliteal artery aneurysm repair, done in a different time or were they were combined repairs?

Dr Harbuzariu: All these operations were done in one procedure. The only time when we actually staged the procedure was in a patient who had a bilateral profunda femoris artery aneurysm and we came back for the other site. Regarding the first question, three patients actually had associated aneurysms in more than one location. There was no correlation between associated aneurysmal disease and the symptomatology related to the profunda femoris artery aneurysm.