Hybrid Endovascular Repair Combined With Surgical Hematoma Evacuation for a Giant Ruptured Spontaneous Femoral Artery Pseudoaneurysm

Spontaneous femoral artery pseudoaneurysms (SFAPs) represent a rare vascular entity. We report the successful hybrid management of a large, wide-necked ruptured SFAP in an 85-year-old male. Computed tomography angiography (CTA) confirmed a massive pseudoaneurysm originating from the distal right superficial femoral artery (SFA) with severe circumferential arterial calcification. Given the prohibitive risks of conventional open repair due to advanced age, comorbidities, and lesion complexity, a hybrid approach was employed: endovascular repair with a self-expanding covered stent, followed by open surgical evacuation of the organized hematoma. This strategy achieved complete pseudoaneurysm repair, effective hematoma evacuation, and preserved distal perfusion without major complications. A brief review of the etiology, diagnostic considerations, and contemporary therapeutic algorithms is provided to contextualize this rare presentation.