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Profunda femoris artery aneurysms (PFAAs) are rare and difficult to diagnose in the early stage. They are often found due to the presence of complicated conditions, such as rapid expansion, rupture, or acute lower limb ischemia. Surgical procedures such as aneurysmectomy and endoaneurysmorrhaphy tend to be technically challenging because of the patient status and the extent of the aneurysm. We experienced three cases of PFAAs that were treated by proximal ligation (PL) without complete control of the distal branches. The exclusion of PFAAs was confirmed by duplex ultrasound or angiography at the end of the operation. There was no mortality in the perioperative period. During a 12-month follow-up, all cases exhibited complete exclusion of aneurysms with marked size reduction. Based on these findings, we propose that PL, with a careful follow-up for PFAA exclusion and distal limb circulation, could be an alternative treatment for complicated PFAAs.

However, there have been reports that stent-graft limbs with an expanded polytetrafluoroethylene (ePTFE) graft surrounded by a helical stent structure perform better than those with polyester surrounded by a Z-stent with unsupported gaps when deployed in the EIA. 6,7 L imb occlusion is the third most common etiology for reintervention after endovascular aneurysm repair (EVAR), with a reported incidence between 2.6% and 7.4%, 1,2 and the risk sharply increases when the stent-graft limb is deployed in the external iliac artery (EIA). Stent-graft limb deployment in the common iliac artery (CIA) reports an incidence of limb occlusion between 1.0%

Purpose: To share our hybrid endovascular experiences using chimney or sandwich stent grafts for acute aortic arch pathologies. Methods: Hybrid procedures for a distal aortic arch aneurysm and an ascending anastomotic aortic aneurysm rupture were reported. Right to left common carotid and left axillar artery bypasses were located. Covered stents were inserted into the inominate artery, with the flow-proximal end located in the ascending (standard chimney) or the descending aortic stent graft (retrograde sandwich). Results: Both cases had no signs of brain ischemia. Aneurysms are decreasing in size. Conclusion: Chimney and sandwich techniques were technically feasible in the complex and acute situations.