Anastomotic Pseudoaneurysm Following Aorto-femoral Artery Reconstruction / 日本心臓血管外科学会雑誌

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.