(See also Aneurysms.)
Approximately 80% of peripheral artery aneurysms are popliteal aneurysms, and the majority of the remaining are iliofemoral aneurysms (1, 2). Aneurysms at these locations may accompany abdominal aortic aneurysms, and > 50% are bilateral. Rupture is relatively infrequent, but these aneurysms may lead to thromboembolism with acute distal artery occlusion. Peripheral artery aneurysms occur in men much more often than in women (at least 6:1), and mean age at presentation is in the 60s (3). Aneurysms in arteries supplying the arm are relatively rare and often traumatic; they may cause limb ischemia, distal embolism, and, when extending to the aortic arch, stroke.
Infectious (mycotic) aneurysms may occur in any artery but are most common in the femoral artery. They are usually due to salmonellae, staphylococci, or Treponema pallidum, which causes syphilitic aneurysms.
Common causes of peripheral artery aneurysms include:
Trauma (eg, popliteal artery entrapment)
Infection (eg, septic emboli, which cause mycotic aneurysms)
Peripheral artery aneurysms are usually asymptomatic at the time of detection. Thrombosis or embolism (or rarely, aneurysm rupture) often leads to acute limb ischemia, in which extremities are painful, cold, pale, paresthetic, and/or pulseless. Infectious aneurysms may cause local pain, fever, malaise, and weight loss.
Diagnosis is by ultrasound, magnetic resonance angiography, or CT angiography. Popliteal aneurysms may be suspected when physical examination detects an enlarged, pulsatile artery; the diagnosis is confirmed by imaging tests.
Risk of rupture of extremity aneurysms is low but increases with increasing diameter above 2 cm. For leg artery aneurysms, surgical repair is elective. Repair is recommended for all symptomatic popliteal aneurysms, and for asymptomatic popliteal aneurysm ≥ 2 cm in diameter. Femoral artery aneurysms should be repaired when symptomatic or when twice the size of the normal blood vessel (4).
Surgical repair is indicated for some arm artery aneurysms (5). The affected segment of artery is typically excised or ligated and replaced with a graft. Overall limb salvage rate after surgical repair of upper extremity aneurysms is 94 to 98% (6, 7).
In certain patients, placement of an endovascular stent graft is another option for repair (8).
References
1. Dawson J, Fitridge R. Update on aneurysm disease: current insights and controversies: peripheral aneurysms: when to intervene - is rupture really a danger? Prog Cardiovasc Dis 2013;56(1):26-35. doi:10.1016/j.pcad.2013.05.002
2. Diwan A, Sarkar R, Stanley JC, Zelenock GB, Wakefield TW. Incidence of femoral and popliteal artery aneurysms in patients with abdominal aortic aneurysms. J Vasc Surg 2000;31(5):863-869. doi:10.1067/mva.2000.105955
3. Körfer D, Grond-Ginsbach C, Hakimi M, Böckler D, Erhart P. Arterial Aneurysm Localization Is Sex-Dependent. J Clin Med 2022;11(9):2450. doi:10.3390/jcm11092450
4. Anderson JL, Halperin JL, Albert NM, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127(13):1425-1443. doi:10.1161/CIR.0b013e31828b82aa
5. Zheng A, Sen I, De Martino R, et al. Presentation, treatment, and outcomes of brachial artery aneurysms. J Vasc Surg 2025;81(5):1120-1130. doi:10.1016/j.jvs.2025.01.001
6. Dragas M, Davidovic L, Kostic D, et al. Upper extremity arterial injuries: factors influencing treatment outcome. Injury 2009;40(8):815-819. doi:10.1016/j.injury.2008.08.012
7. Klocker J, Falkensammer J, Pellegrini L, Biebl M, Tauscher T, Fraedrich G. Repair of arterial injury after blunt trauma in the upper extremity - immediate and long-term outcome. Eur J Vasc Endovasc Surg 2010;39(2):160-164. doi:10.1016/j.ejvs.2009.11.019
8. Saunders JH, Abisi S, Altaf N, et al. Long-term outcome of endovascular repair of popliteal artery aneurysm presents a credible alternative to open surgery. Cardiovasc Intervent Radiol 2014;37(4):914-919. doi:10.1007/s00270-013-0744-6
Key Points
Peripheral artery aneurysms occur mainly in men; the most common location is the popliteal artery.
Complications are rare and include rupture and thromboembolism.
Treat all lower extremity aneurysms when symptomatic; asymptomatic popliteal artery aneurysms when ≥ 2 cm; and some upper extremity aneurysms.
