Femoral Artery Bypass Graft Pseudoaneurysm Rupture in a Transfemoral Amputee: A Case Report.

We describe the case of a patient with an actively bleeding pseudoaneurysm associated with remnants of a polytetrafluoroethylene (PTFE) femoral bypass graft in their transfemoral residual limb. Initial graft placement was due to peripheral arterial disease. During subsequent transfemoral amputation, remnants of the non-patent graft were retained in the residuum. Following four years of lower limb prosthesis use, a proximal anastomosis pseudoaneurysm developed (with avulsion of graft remnants). The patient presented to clinic with a 5-day history of increased left groin fullness and largely non-radiating pain (rated 10/10). He was diagnosed with a pseudoaneurysm (1.9 cm) originating from the left common femoral artery and an associated hematoma (8 cm) on CT; this required emergent reoperation. This case highlights the importance surrounding the decision to leave or explant neovascularization materials, which may carry significant risk for infection or physical disruption complications in residual limbs.