spontaneous pseudoaneurysm of the femoral artery is extremely a rare entity.(1 ) it can be secondary to the rupture of a true aneurysm , but in most events the cause is unclear.(2 ) most patients with non - atherosclerotic pseudoaneurysms of sfa are asymptomatic initially and later present with a pulsatile , expanding mass along the anatomical course of sfa in the thigh and have a history of some trauma or surgical procedure.(3 ) due to their complications , large pseudoaneurysms require some kind of intervention . if not treated , they are at risk for rupture , infection , distal embolization or arteriovenous fistula formation .
( 1 ) we report a young patient with spontaneous femoral artery pseudoaneurysm without any history of trauma or vascular intervention successfully treated surgically .
a 29-year - old healthy man presented with right thigh swelling since 2 months which is painful throbbing in nature and aggravated by walking .
there was no history of local trauma and he had never suffered peripheral vascular disease . on presentation , he was hemodynamically stable and there was a tender swelling at the medial aspect of right mid thigh which was pulsatile .
ct angiogram was done which showed a pseudoaneurysm of the lower third of femoral artery .
ct angiogram showed a pseudoaneurysm of the lower third of femoral artery a surgical excision of the pseudo - aneurysm was done under general anesthesia .
after evacuation of hematoma , there was a large defect in the wall of the artery .
therefore , a greater saphenous vein interposition graft was used to maintain the vascular continuity .
formation of a femoral artery pseudoaneurysm is not infrequent after femoral arterial access , and it occurs in up to 0.7% of the diagnostic procedures and in up to 8% of the interventional procedures .
( 4 ) recently , there has been a significant decrease in both major and minor vascular complications after diagnostic and therapeutic procedures with an incidence of pseudoaneurysm less than 0.3 % .
( 5 ) spontaneous pseudoaneurysm of the superficial femoral artery in the young age group is a rare occurrence .
some of the false aneurysm may close spontaneously but rupture is a major concern followed by thrombosis , distal embolization and compression of adjacent structures .
( 3 ) atherosclerosis has been proposed by several authors as an etiologic factor in spontaneous perforation of the femoral arteries or its branches .
( 6 - 8 ) in these case reports , the patients were elderly with atherosclerotic changes in their peripheral arteries and weakening of the arterial walls could have led to spontaneous rupture .
patients who have inherited connective tissue disorders such as ehlers - danlos have also been reported to present with spontaneous rupture of their arteries because of the fragility of their arterial walls .
( 9 ) . our patient , however , was young and there was no evidence of atherosclerotic changes in his arteries on the angiogram or during surgery .
furthermore , he did not have any clinical features to suggest an inherited connective tissue disorder .
there was also no history for any trauma and for which we labeled him to have a spontaneous femoral artery pseudoaneurysm .
therapeutic options for femoral pseudoaneurysm include open surgical repair , ultrasound - guided compression , ultrasound - guided thrombin injection , coil embolization , and endovascular repair using stent - grafts .
( 10 ) particularly in young patients , an appropriate approach is surgical exploration with hematoma evacuation and arterial repair by means of arterial suture , patch angioplasty , or graft interposition . ( 2 ) femoral artery pseudoaneurysm has been a common complication after the wide use of femoral artery access for diagnostic and therapeutic procedures . however , spontaneous rupture of the artery without trauma remains a rare entity .
as there are many evolving types of management , the surgical intervention may has superiority when there is a suspicious of underlying vascular pathology .
 spontaneous femoral artery pseudoaneurysm is a rare disease and reported cases are very few . most of them are related to underlying pathology either atherosclerotic disease or connective tissue disease . 
 we present a 29-year - old healthy man with two months history of a painful pulsating mass at the level of the lower right thigh without any previous history of trauma , surgery or puncture of the femoral artery . 
 an angiogram revealed a right superficial femoral artery pseudo - aneurysm . 
 it was treated surgically by resection of the aneurysm , reconstruction with inter - positional saphenous vein graft . 
 we reported this case because of its rare incidence in the young patient with no underlying pathology . 
INTRODUCTION
CASE REPORT
DISCUSSION