Management of a Rapidly Expanding and Ruptured Common Femoral Artery in a Patient with Active Behcet’s Disease.
Jonathan Lee, Mohammad Kassem, MD, Suzy Lin, MD, Prashant Upadhyaya, MD, Vivian Gahtan, MD, Kwame Amankwah, MD.
SUNY Upstate Medical University, Syracuse, NY, USA.
Behcet’s disease (BD) is a rare autoimmune, multisystemic inflammatory disease that involves the cardiovascular, gastrointestinal, and central nervous systems. The disease is characterized by a classic triad of recurrent aphthous ulcers, genital lesions, and uveitis. In 7 – 40% of patients, vascular sequelae secondary to inflammatory vasculitis may develop. Venous disease is more frequently associated with vascular complications of BD; however, 1.5 – 2.2% of patients may develop rapidly expanding arterial aneurysms. Limited data exists regarding pre- and postoperative management. We present a case of a young patient who developed a spontaneous common femoral artery (CFA) pseudoaneurysm which was successfully treated with surgical intervention.
A 29 year old male in the active phase of BD, presented with worsening left groin pain and a pulsatile mass. Initial ultrasound demonstrated a left common femoral aneurysm. The patient has an extensive medical history including mediastinal fibrosis complicated by SVC syndrome, DVT of the extremities, and bilateral chylothoraces. The patient denied any trauma to the area. Immunosuppressive therapy (IST) was initiated to achieve remission prior to surgery; however, the patient developed worsening pain with CTA demonstrating a pseudoaneurysm which increased in size. He underwent surgical resection of the involved artery and an interposition PTFE graft. A left rectus femoris muscle flap was utilized to fill in dead space and coverage of the graft. The patient was maintained on anticoagulation and IST postoperatively and will require close postoperative surveillance.
Surgical intervention in patients with Behcet’s disease is often complicated by graft occlusion and anastomotic pseudoaneurysm formation. The results of our case with follow-up data will contribute to the currently limited information of a rare, but serious manifestation of BD.
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