Surgical Management of a Pulsatile Mass in the Distal Thigh: A Case Report of Post-Traumatic Pseudoaneurysm

Abstract

Pseudoaneurysms are uncommon vascular complications arising after arterial wall disruption, most commonly following blunt or penetrating trauma. Delayed presentation several years after injury is rare, particularly in association with high-velocity blast fragments. A 20-year-old woman presented with a progressively enlarging pulsatile mass in the left distal thigh over four months. She also reported worsening pain, numbness, and difficulty walking. Her history included a blast-fragment injury to the same limb eight years earlier. Doppler ultrasonography demonstrated a large pseudoaneurysm of the distal superficial femoral artery (SFA), which was confirmed on CT angiography. The patient underwent open surgical repair with pseudoaneurysm resection and revascularization using a reversed saphenous vein interposition graft. Recovery was uneventful, and follow-up Doppler studies demonstrated normal limb perfusion. Traumatic pseudoaneurysms of the SFA typically present early after injury; however, delayed manifestation years after trauma is uncommon. In this case, chronic vessel-wall contusion from a retained or high-velocity fragment likely contributed to late pseudoaneurysm development. Large or symptomatic pseudoaneurysms are best managed surgically due to the risk of rupture, thrombosis, and neurovascular compression. Open repair with autologous vein grafting remains an effective option for restoring arterial continuity in young patients.