Zhang Hongchao, cardiovascular surgery department, Air Force General Hospital, right deep femoral artery pseudoaneurysm embolization and angioplasty patient Xiao Jinfu, male, 65 years old, from Yi County, Hebei Province. Two years ago, he fell down accidentally while riding a motorcycle, and his right leg was compressed without fracture. A swollen mass of about 5*5cm appeared under the right groin with bruising and no obvious pain, so he did not pay attention to it, and the swelling was relieved after giving hot compresses, and the skin was not obviously bruised, but the mass could still be palpated, so he was not systematically treated. The patient seemed to be unaware of the presence of a lump on his leg, which did not affect his life, but was not aware of the hidden danger of life, because the lump did not feel anything when it appeared, so the patient ignored it, but the lump did not grow quietly, but slowly. Fortunately, the patient was sensitive to the discovery, and in the last year, although there was no pain, no swelling of the lower limbs, and no bruising of the skin, the mass in the right groin area was still clearly visible, with a strong throbbing sensation when lightly touched by hand, and progressive enlargement. What is this? The patient and his family felt a touch of unease and panic and embarked on a medical journey to find out what was going on. The first stop was the local county hospital, where ultrasound was considered a pseudoaneurysm of the femoral artery, which was risky and difficult to operate on, and surgical treatment was recommended. Is this really the case? The patient and his family were somewhat reluctant – a mass that they did not think was so big a deal. So they embarked on a journey to Beijing for medical treatment. The first stop was straight to the PLA General Hospital, where ultrasound suggested: femoral artery pseudoaneurysm, but no systematic treatment plan was given, and the mystery of the mass remained unsolved. At the second stop, the patient came to Beijing Anzhen Hospital, where surgical treatment was recommended after a CTA examination of the lower limb arteries. At this point, the patient’s family realized the seriousness of the problem, but various questions about how to operate and what kind of surgery it was, etc., caused everyone to fall into a new panic and anxiety. The patient and his family urgently needed to know the answer, so after many inquiries and careful consideration, they came to our department for treatment. On examination after admission: a pulsating mass, 6*9 cm, with clear border and soft texture, no redness, swelling and bruising on the surface, with intact skin and no rupture, was seen 1 cm below the right groin of the patient. Ultrasound suggests:Pseudoaneurysm formation with attached thrombosis is seen in the right inguinal region, with a cystic mass of 6.5*10.3cm, the same as the external iliac artery, with red and blue flow signals. Can we give a satisfactory answer to the patient and the medical staff when the Spring Festival is approaching? A thorough surgical plan and thorough preparation are necessary. A seemingly simple deep femoral aneurysm is indeed a serious challenge to our technique. If we analyze the case, we can easily find some characteristics of the case: if we use the traditional surgical approach, it is safer, but there are potential problems, such as the risk of incision, large surgical incisions, more complications such as postoperative lymphatic vessels leakage, etc. In addition, the postoperative recovery time is long, which is not the best choice for the patient in this particular time. Is there a simpler, more economical and less invasive method? After discussion, various surgical options were proposed:The most ideal treatment was to seal the aneurysmal opening with a small overlapping stent, however, according to the patient’s lower extremity vascular CTA, the patient’s iliac artery was severely tortuous with a small angle, and the right iliac artery was tortuous at a right angle, making access difficult, and the other overlapping stent had poor compliance, making implantation difficult and costly as an alternative. If treated with traditional spring coil alone, huge false lumen, large cost, inaccurate efficacy, and the possibility of long-term discomfort are also included as options. There is also the option of puncturing through the left side, turning the mountain to the right deep femoral artery, closing the aneurysm mouth with a small balloon, injecting thrombin into the aneurysm through the balloon, releasing the balloon after the formation of thrombus itself, and covering the aneurysm mouth with 2 bare stents, which is less traumatic and less expensive, and at the same time can prevent the thrombus from dislodging from the aneurysm to the deep femoral artery, this surgical option is more ideal. It is impossible to predict what the actual operation will be like, so adequate preoperative preparation is especially important. The choice of access: the patient was highly obese and the femoral artery was difficult to puncture (the fatty femoral artery was difficult to touch and the puncture requirement was very high, and the consequences were unimaginable if something went wrong). On 2016-02-03, the surgery was planned, the patient was obese, the femoral artery was difficult to palpate, the puncture was a challenge, and with our experience, the puncture was successful. The placement angiogram showed that the patient’s iliac artery was severely tortuous, with many tortuous near-right angles. All operations needed to be done carefully to prevent the catheter from fracturing or breaking, which could cause bleeding, and to choose between various branches and pseudoluminal vessels several times, which could easily lead to rupture of the aneurysm and cause hemorrhage. The operation was intense and orderly, after repeatedly confirming the caliber of the tumor opening and the presence of outflow tracts, the balloon was delivered to the tumor mouth smoothly, and the thrombin was injected through the balloon, and we were waiting to see if a thrombus could be formed. 20 min passed, and the fluoroscopic view showed that the residual contrast agent in the tumor no longer disappeared, and the thrombus itself was formed, so we saw the hope of success. After discussion among the doctors, it was decided to replace the stent with 2 bare stents. After precise positioning, the stent was released smoothly, and the repeat imaging showed that the stent was well positioned, adhered well to the wall, no obvious blood flow penetrated into the tumor, and the tumor pulsation disappeared. The patient is recovering well and is expected to return home for the Chinese New Year 2 days before the Spring Festival. This surgery cleverly used balloon to block the tumor opening and thrombin to promote autologous thrombus formation, saving the patient nearly 100,000 RMB. We gave the patient a great gift with wisdom, love and responsibility!