Management of traumatic giant superficial femoral artery pseudoaneurysm: a case report

Introduction and Importance: Pseudoaneurysms (PSAs) are localized vascular dilatations resulting from arterial wall disruption, where blood leakage is contained by surrounding tissue or remaining arterial layers. While some PSAs may spontaneously resolve, they pose significant risks, including rupture, distal embolization, thrombosis, and compression of adjacent structures. Traumatic PSAs can mimic other soft tissue pathologies, complicating timely diagnosis. We report a rare case of a giant traumatic superficial femoral artery (SFA) pseudoaneurysm, emphasizing the importance of early recognition and surgical intervention. Case Presentation: A 22-year-old male presented with a two-week history of pain and swelling in the mid-left thigh following minor trauma from a metal fragment. Physical examination revealed a pulsatile mass with an audible bruit. Doppler ultrasound and CT angiography confirmed a large SFA pseudoaneurysm with intact distal flow. Surgical intervention involved resection of the aneurysmal sac and interposition grafting using the saphenous vein. The patient recovered uneventfully and remained asymptomatic at six months postoperatively. Clinical Discussion: The diagnosis of traumatic SFA pseudoaneurysms may be delayed due to their deep location and variable clinical presentation. Management strategies depend on lesion size, symptoms, and anatomical considerations. Although endovascular and percutaneous techniques exist, open surgical repair remains the gold standard for large or symptomatic pseudoaneurysms. Our case demonstrates how even minor trauma can cause significant vascular injury, and highlights the need for prompt evaluation and treatment to prevent serious complications like limb ischemia or rupture. Conclusion: This case illustrates successful management of a giant posttraumatic SFA pseudoaneurysm via saphenous vein graft interposition. It reinforces the importance of early diagnosis and surgical treatment in preventing life- or limb-threatening outcomes. Clinicians should maintain a high index of suspicion for PSA in patients with a history of even minor penetrating trauma and localized swelling.