Delayed Deep Vein Thrombosis Secondary to Femoral Artery Pseudoaneurysm: A Case Report and Literature Review

Background : Femoral artery pseudoaneurysm (FAP) is an uncommon but potentially serious complication following vascular or orthopedic interventions. In rare instances, it can lead to deep vein thrombosis (DVT) due to mechanical compression of adjacent veins. Case Presentation: We report the case of a 68-year-old woman with a history of ischemic heart disease and prior hip arthroplasty, who presented with right lower limb swelling and a pulsatile inguinal mass. Imaging revealed a large pseudoaneurysm of the right common femoral artery compressing the femoral vein, with associated chronic DVT. The patient underwent successful endovascular repair with a covered stent, followed by anticoagulation therapy. Complete resolution of symptoms and no recurrence were observed at follow-up. Conclusion: This case highlights the rare but clinically important occurrence of delayed DVT secondary to FAP compression, manifesting more than a decade after hip surgery. A review of the literature underscores the variable presentations, diagnostic challenges, and evolving management strategies, including endovascular approaches, for similar cases. Prompt recognition and individualized treatment are essential to prevent complications such as venous insufficiency or embolic events. Clinicians should maintain vigilance for vascular etiologies in patients with unilateral limb swelling and remote surgical history. Duplex ultrasonography and CT angiography are vital for diagnosis, and endovascular repair can provide a safe and effective therapeutic option in complex FAP-associated DVT cases.