A Surgical Case for Unilateral Lower-extremity Paralysis Due to Common Femoral Artery True Aneurysm

Abstract

Femoral artery aneurysm complicated with lower-extremity paralysis is rare. An 84-year-old male complained of sudden right lower-extremity paralysis. The Manual Muscle Testing (MMT) scale was 0 with paralysis of both the femoral and sciatic nerves. Head CT and head/spine MR revealed neither clear brain nor spinal-cord lesions causing the lower-extremity paralysis. Whole-body contrast-enhanced CT, however, demonstrated a right common-femoral artery aneurysm with thick mural thrombus. No history of trauma was present. Because it was considered at this point that the aneurysm rapidly expanded at risk of rupture and compressed the femoral nerve, urgent surgery was performed. The aneurysm was replaced with a 10 mm graft, and the deep femoral artery was reconstructed with end-to-side anastomosis. Despite aggressive rehabilitation, the paralysis improved merely to ab MMT scale of 1 in 2 weeks postoperatively. Considering the sudden onset of paralysis, involvement of both the femoral and sciatic nerves, and delayed improvement of paralysis, (not direct compression of the nerve by the aneurysm but rather) thromboembolism from the mural thrombus of the aneurysm to the alimentary vessels of the nerves may cause the paralysis. The true cause, however, could not be confirmed.