peripheral arterial aneurysms are rare , and among these , deep femoral arterial ( dfa ) aneurysms are extremely rare [ 13 ] .
dfa aneurysms are not associated with any characteristic symptoms , and their early diagnosis is difficult .
these aneurysms have a high rate of rupture , and surgery plays an important role in their treatment .
however , standard methods have not yet been established because of the rarity of dfa aneurysms [ 36 ] .
we describe a case of dfa aneurysm in a patient who was successfully treated with aneurysmectomy and revascularization with an artificial blood vessel graft .
a 58-year - old man presented with paralysis and pain in the left leg , and a mass was found in his thigh . because of the growth of the mass and the worsening of his symptoms , the patient visited a neighboring hospital .
physical examination revealed a pulsatile mass with a diameter of 8 cm in the left thigh .
multidetector computed tomography performed in our hospital revealed a large dfa aneurysm with an intraluminal thrombus ( fig .  1 ) .
surgical intervention was planned because of the large size of the aneurysm , the high risk of perforation and the worsening symptoms . 

figure  1:multidetector computed tomography revealed a large dfa aneurysm ( arrows show aneurysm ) .
the common femoral artery , superficial femoral artery , superficial femoral vein and deep femoral vein were recognized and preserved ( fig
.  2a ) . after clamping the dfa proximal and distal to the aneurysm , we opened the sac and found a massive thrombus .
aneurysmectomy and revascularization of the distal dfa with an artificial blood vessel graft were performed ( fig . 
pathological examination of the specimen revealed atherosclerosis in the vascular wall and confirmed that it was a true aneurysm . 

figure  2:(a ) the common femoral artery , superficial femoral artery , superficial femoral vein and deep femoral vein were recognized and preserved .
( b ) aneurysmectomy and revascularization of the distal dfa with an artificial blood vessel graft were performed .
( a ) the common femoral artery , superficial femoral artery , superficial femoral vein and deep femoral vein were recognized and preserved .
( b ) aneurysmectomy and revascularization of the distal dfa with an artificial blood vessel graft were performed . following surgery ,
a follow - up multidetector computed tomography scan showed good blood flow in the graft , superficial femoral artery and popliteal artery ( fig . 
figure  3:a follow - up multidetector computed tomography scan showed good blood flow in the graft , superficial femoral artery and popliteal artery .
a follow - up multidetector computed tomography scan showed good blood flow in the graft , superficial femoral artery and popliteal artery .
although many dfa aneurysms have been associated with other peripheral aneurysms or peripheral occlusive diseases , there was no evidence of aneurysms or occlusive lesions in the other arteries of our patient [ 4 , 7 , 8 ] .
therefore , we consider our case of an isolated dfa aneurysm to be extremely rare .
there are no characteristic symptoms of dfa aneurysms in the early stage , and their diagnosis is difficult .
they are often found accidentally or after their enlargement , when symptoms include pulsating groin swelling , paralysis or pain in the leg , which were the symptoms that our patient experienced . enlarged dfa aneurysms
must be treated because of the high risk of rupture , which may cause severe complications , including hemorrhagic shock , ischemia of the foot , thigh embolization , thrombophlebitis and sciatic or femoral neuropraxia [ 1 , 5 , 9 , 10 ] .
several treatment options , including simple ligation , revascularization of the distal dfa and bypass grafting to the popliteal artery , exist for dfa aneurysms ; however , standard methods have not been established because of the rarity of dfa aneurysms . in our case
, we performed an aneurysmectomy and revascularization to the distal dfa with an artificial blood vessel as the graft .
revascularization was performed to avoid thigh ischemia and preserve the collateral circulation if ipsilateral peripheral occlusive disease occurred .
we believe that revascularization to the distal dfa should be done whenever it is technically feasible . in previous reports ,
if the patient must undergo operations such as coronary artery bypass grafting or other peripheral arterial bypass grafting , the saphenous veins will be required for those surgeries .
therefore , we did not use the saphenous vein as the graft . in this case
, we consider the surgery a success because the patient recovered well from the surgery without complications , his symptoms improved and the blood flow in the leg was preserved . in conclusion , dfa aneurysms are extremely rare .
surgery plays an important part in the treatment of this disease , but standard methods have not been established because of its rarity . in our patient , we successfully performed an aneurysmectomy and revascularization to the distal dfa with an artificial blood vessel graft .
 a 58-year - old man presented with paralysis and pain in the left leg , and a mass was found in his thigh . because of the growth of the mass and the worsening of his symptoms , the patient visited our hospital . 
 multidetector computed tomography revealed a large deep femoral arterial ( dfa ) aneurysm . 
 surgical intervention was planned because of the large size of the aneurysm , the high risk of perforation and the worsening symptoms . 
 aneurysmectomy and revascularization of the distal dfa with an artificial blood vessel graft were performed . 
 dfa aneurysms are extremely rare . 
 these aneurysms have a high rate of rupture , and surgery plays an important role in their treatment . 
 however , standard methods have not yet been established because of their rarity of dfa aneurysm . 
 we describe a case of dfa aneurysm in a patient who was successfully treated with aneurysmectomy and revascularization with an artificial blood vessel graft . 