Recurrent femoral anastomotic false aneurysms: is long term repair possible?

This study was undertaken to evaluate the operative problems and the fate of patients operated on for recurrent femoral anastomotic false aneurysms, following aortofemoral bypass. It was found that 58 of 66 anastomotic false aneurysms which developed after aortoiliac or aortofemoral reconstruction were located at the femoral level, six at the anastomosis of the graft to the aorta and two at the iliac artery anastomosis. Six recurrences developed after surgical repair of femoral anastomotic false aneurysms but there were none after repair of aortic or iliac anastomotic false aneurysms. Of the six recurrences one patient was treated by direct repair and the remaining five by interposition of a prosthetic graft. There were no ischaemic complications or recurrences in a mean of three years. Elective, repeated repair is therefore a successful method of treating anastomotic false aneurysms. Deep sutures should be inserted into the arterial wall, tension should be avoided by placing an interposition graft when necessary, using a careful aseptic technique. Patients should be told to avoid extreme extension and rapid flexion-extension of the hip joint for the rest of their life.

[Anastomotic aneurysm following insertion of aorto-iliac or aorto-femoral prosthesis. Treatment and long-term results]. / Anévrismes anastomotiques après prothèse aorto-iliaque ou aorto-fémorale. Traitement et résultats à long terme.

This retrospective study was conducted to evaluate the long-term results obtained after treating anastomotic false aneurysm occurring after implantations of aorto-iliac or aorto-femoral prostheses in order to identify optimal treatment. During a 20-year period, 66 anastomotic aneurysms were discovered and treated in 48 patients. The mean delay after initial surgery was 6.3 years. Locations observed were femoral (n = 58) aortic (n = 6) and iliac (n = 2). Five aneurysms were revealed by an acute ischaemia, three others by bleeding and one by abdominal pain. The 57 others were diagnosed in an equal proportion either during physical examination or periodic imaging. Aortic and iliac aneurysms were treated by complete or partial replacement of the prosthesis. There were two urinary fistulas, one being fatal and one recurrent haemorrhage followed by death. Femoral aneurysms were treated in 4 out of 5 cases by interpositioning a prosthesis and in 1 out of 5 cases by simple resuturing. There was one fatal cerebral haemorrhage, 4 cases of early thrombosis and 6 cases, of recurrent anastomotic aneurysm (10%). The clinical course required amputation in 3 patients. In this series, the overall outcome was satisfactory. For aneurysms of aortic or iliac anastomoses, one must avoid dissecting the prosthesis-ureter crossover and blind extraction of a branch which can lead to urinary fistulas. For femoral anastomoses, the following recommendations are important: conservation of the collaterals, suturing deeply into healthy tissue and interposition of a new prosthesis in case of tension. Cases of recurrent aneurysm are rare and should be treated with the same careful procedures.