ABSTRACT
One of the complications after Dacron vascular reconstruction for both occlusive disease and aneurysmal disease is anastomotic false aneurysm. We reviewed 22 aneurysms of 13 patients who underwent aorto-femoral reconstruction in our department during the past 14 years. The indication for initial prosthetic reconstruction had been an atherosclerosis obliterans (ASO) in 12 patients and infrarenal aortic occlusion with liver abscess in 1 patient. The mean interval from initial surgery was 40.6 months (range, 2 to 142 months). Seven anastomotic pseudoaneurysms occurred within 6 months after operation and the remaining fifteen occurred in the late follow-up period (22 to 142 months). Unilateral aneurysm was found in 7, bilateral in 5 and 5 in one patient. Distal femoral anastomotic symptoms at presentation included critical limb ischemia in one, inguinal pain in three, abscess in two, mass in seven and asymptomatic in seven. Proximal aortic anastomotic symptoms included abdominal pain in one case and another case was asymptomatic. The asymptomatic aneurysm was diagnosed by routine sonographic surveillance. Surgical management in all patients included aneurysmectomy with aneurysmoplasty in 2 and prosthetic graft interposition or bypass in 11 as an elective operation, graft extirpation with extraanatomic bypass in one and graft replacement in one as an urgent operation, and thrombectomy and/or graft replacement in 6 as an emergency operation. All of the aneurysms are pseudoaneurysms were confirmed by pathological examination. Host arterial-wall degeneration was the main cause of aneurysm formation in most cases (85.7%). In our opinion, patients should be periodically studied after aortic grafting with abdominal ultrasonography for early detection of this potentially serious complication. Early diagnosis and elective repair of these aneurysms should be recommended whenever possible because of their propensity to develop serious complications.
ABSTRACT
It is presumed that visceral ischemia is caused as a result of fighting between the lower limb and intraperitoneal organs to steal blood in aortoiliac occlusive disease (AIOD). Accordingly, an investigation has been made of this “aortoiliac steal” phenomenon. Out of 65 AIOD patients, the case in whom the main collateral circulation to the lower limb was found to originate in the intraperitoneal visceral arteries by angiography were only 2 (3%), both of which showed, however, no visceral ischemic symptom. Intraoperative changes in pelvic visceral hemodynamics were observed in 19 cases undergone either aorto-bifemoral or axillo-bifemoral bypass operation (AFB) using Doppler's ultrasonic trans-anal method. As a result, visceral circulation was maintained favorably even after AFB, further suggesting the possibility that not only the circulation of the inferior limb but the visceral circulation is improved directly by AFB. Visceral ischemia is considered to occur in the patient in whom concomitant stenotic lesion is present in the celiac artery or superior mesenteric artery, for which full attention should be paid to visceral circulation also in the patients with ischemia in the lower limb.