A systematic review of the diagnosis, management, and outcomes of true profunda femoris artery aneurysm

Objective: True profunda femoris artery aneurysm (TPFAA) is rare. Most cases of profunda femoris artery aneurysm are classified as pseudoaneurysms. TPFAAs are mostly asymptomatic, but some are manifested with pain, swelling, paresthesia, gait and movement disturbances, thrombosis, and rupture. There is a paucity of evidence on the effectiveness of diagnostic and therapeutic measures for management of TPFAA. The aim of this paper was to systematically review the incidence, diagnosis, and management of TPFAA. Methods: A comprehensive systematic review on the diagnosis and management of TPFAAs was conducted by a search through PubMed, Cochrane, Embase, and Google Scholar databases to identify and to evaluate publications on TPFAA since 2012. Only publications on TPFAA were included in this review. Results: A total of 19 publications published from 2012 were included in the review. The studies were 18 case reports and a cadaver study reporting 27 TPFAAs in 26 patients with a mean age of 69.6 years. Rupture was reported in 18.5% of the cases (n = 5); the conventional clinical presentation of unruptured TPFAA was reported in 48% of cases (n = 13), with 40.9% of unruptured aneurysms being asymptomatic (n = 9). Computed tomography angiography was used as a diagnostic tool in 85.2% of the cases (n = 23); Doppler ultrasound was applied in 33.3% of cases (n = 9). The common therapeutic approaches were resection and revascularization (n = 13 [48.1%]) and ligation or resection without reconstruction (n = 6 [22.2%]). Cumulative analysis for cases reported before and after 2012 yielded similar results. Conclusions: Review of the current literature supports that computed tomography angiography and Doppler ultrasound are the mainstay diagnostic approaches for TPFAA. Surgical repair through ligation, resection, and revascularization remains the most common and effective therapeutic procedure. Endovascular embolization is recommended for aneurysms when surgery is not tenable because of the patient's comorbidities and the aneurysm's anatomy.