Background: Common femoral artery aneurysms are rare and are usually associated with aneurysms at other sites, mainly the aorta, iliac, popliteal, superficial femoral, and profunda femoral artery. This combination poses the challenge of synchronous repair for clinically relevant aneurysms. Although endovascular abdominal aortic aneurysm repair is the main type of treatment for abdominal aortic aneurysms nowadays, this is not true for common femoral aneurysms, where open repair remains the gold standard. These two distinct operations could be combined in a one-stage procedure when aortoiliac and common femoral aneurysms present simultaneously. This approach potentially saves time and costs, without increasing complications. Methods: A retrospective search was conducted in the Vascular Surgery Department database of a tertiary referral center for vascular surgery, covering procedures from January 2005 to May 2025. Patients were included if they had undergone simultaneous endovascular abdominal aortic aneurysm repair and open repair of a common femoral artery aneurysm. Clinical records, operative details, imaging studies, and follow-up data were reviewed. We additionally provide a literature review regarding this approach. This review additionally incorporates the current knowledge regarding the treatment of common femoral artery aneurysms. Results: Out of 668 endovascular abdominal aortic aneurysm repair procedures, three patients (0.45%) were identified. These three patients were among five patients who were treated for true common femoral artery aneurysm by open repair in the same time interval. All of the patients are currently in good condition without late complications. One patient, who had not performed any follow-up imaging, was diagnosed with large aneurysms at other sites, 10 years later. Conclusions: The combined one-stage endovascular abdominal aortic repair and open repair of a common femoral artery aneurysm by interposition grafting is technically a simple approach that led to satisfactory outcomes.

Background: Brachial artery aneurysms are a rare entity occurring sporadically at all ages. Common causes are trauma, infection, connective tissue disorders, genetic syndromes, immunosuppression, and a history of arteriovenous vascular access. Pseudoaneurysms are mainly of traumatic or iatrogenic origin. Idiopathic true brachial artery aneurysms are even scarcer, attributed to inherited susceptibility for aneurysm formation or to atherosclerosis. Due to the rarity of these aneurysms, we report our experience along with a current literature review. Methods: A retrospective search was conducted in the Vascular Surgery Department database of a tertiary referral center for vascular surgery, covering procedures from January 1991 to October 2025. Patients were included if they had undergone idiopathic true brachial artery aneurysm repair. Clinical records, operative details, imaging studies, and follow-up data were reviewed. We additionally provide a literature review regarding clinical presentation, signs, pathophysiology, diagnosis, and treatment of these aneurysms. Results: Amongst all procedures performed for aneurysmal repair, in the searched period, we identified three patients who met these criteria. All three underwent successful elective operations. Individual characteristics of the retrieved cases are reported. Conclusions: The open repair of true idiopathic brachial artery aneurysms is a technically simple approach that leads to satisfactory outcomes. Endovascular therapy is technically unfavorable in this type of aneurysm.

Background/Objectives: Type II endoleaks (T2ELs) remain one of the most frequent causes of aneurysm sac enlargement following endovascular abdominal aortic aneurysm repair (EVAR). While embolization may be effective in typical T2ELs with a clearly identifiable feeding vessel, management becomes more challenging when no visible communication with a side branch can be demonstrated. Emerging evidence suggests that hypertrophic vasa vasorum may contribute to aneurysm sac expansion in these atypical cases. We present a case of refractory atypical T2EL treated by open conversion and discuss the potential role of the vasa vasorum network in its pathophysiology. Case Presentation: A 77-year-old man presented with lumbar pain ten years after EVAR for a symptomatic abdominal aortic aneurysm. Computed tomography angiography demonstrated progressive aneurysm sac enlargement to 8.5 cm despite three previous translumbar embolization procedures. Multiple areas of contrast pooling were identified within the aneurysm sac, but no clear communication with a feeding side branch was observed. Owing to persistent sac expansion and symptoms, open conversion was performed with partial endograft explantation and reconstruction using a bifurcated PTFE graft. Results: After opening the aneurysm sac and evacuating the thrombus, diffuse bleeding was observed from numerous small vascular orifices distributed throughout the inner sac surface. These findings were considered consistent with a prominent vasa vasorum network. Hemostasis was achieved using a combination of figure-of-eight sutures and electrocautery. The postoperative course was uneventful, and the patient was discharged on postoperative day five. Follow-up imaging demonstrated normal graft patency without complications. Conclusions: This case supports the hypothesis that an extensive vasa vasorum network may contribute to aneurysm sac expansion in atypical T2ELs and possibly endotension after EVAR. In patients with refractory sac enlargement, open conversion remains a definitive treatment option. Further research is needed to clarify the underlying mechanisms and to explore targeted therapeutic strategies aimed at modulating angiogenesis and vascular remodeling.