Anastomotic pseudoaneurysms

Abstract

Anastomotic pseudoaneurysm is a form of false aneurysm, whose wall does not consist of all normal layers of arterial wall. Given the rising number of reconstructive vascular procedures, the increase of anastomotic pseudoaneurysm cases is expected. Therefore, identification of causes, clinical manifestations as well as factors which affect the outcome of operative treatment of anastomotic pseudoaneurysms is of great practical value. This retrospectively-prospective study included 87 surgically treated cases of anastomotic pseudoaneurysms in the period from 1991 to 2002. The most often localization of anastomotic pseudoaneurysms was the inguinal region (68-86.2%). In the majority of cases, they were caused by arterial degeneration in the anastomotic region--56 cases (65.9%) and infection--21 cases (24.7%). The most frequent manifestations of anastomotic pseudoaneurysms were bleeding due to rupture in 26 cases (29.9%) and chronic limb ischaemia in 22 cases (25.3%). An acute limb ischaemia was present in 17 cases (19.5%), the symptoms caused by local compression to the surrounding structures--in 9 cases (10.3%), and in 12 cases (13.8%), the only manifestation of anastomotic pseudoaneurysm was asymptomatic pulsatile mass. In 32 cases (36.8%), surgical treatment involved the resection of anastomotic pseudoaneurysm and graft interposition, whereas in 39 cases (44.8%), bypass procedure had to be performed after the resection. Comorbidity significantly increased mortality in the first 30 days. The use of Dacron graft in primary operation significantly improved early results of operative treatment. Absence of infection as the cause of anastomotic pseudoaneurysm is a statistically important prognostic factor of operative treatment, considering the graft patency, limb salvage, infection, need for reintervention and mortality.

Stent graft repair of anastomotic pseudoaneurysm of femoral–popliteal bypass graft following patch angioplasty

“…Our patient presented with compressive symptoms and unremitting pain. As reported by Marković et al [1], compressive symptomatology compromises only 10% of presenting patients. Other presentations include acute and chronic limb ischemia, bleeding secondary to rupture and an asymptomatic pulsatile mass [1].…”

“…As reported by Marković et al [1], compressive symptomatology compromises only 10% of presenting patients. Other presentations include acute and chronic limb ischemia, bleeding secondary to rupture and an asymptomatic pulsatile mass [1]. Although the majority of PA is secondary to trauma or iatrogenic injury, other etiologic factors are postoperative infection, suture fatigue, poor suture material, postoperative nicotine use, recurrent operations to the same site and mechanical obstruction [7].…”

“…Given the rising number of reconstructive vascular procedures, the increase in anastomotic PA cases is expected [1]. Potential degeneration of biosynthetic grafts with aneurysm formation is a well-known problem with a reported incidence of up to 7% [2].…”

Ruptured Superficial Femoral Artery Anastomotic Pseudoaneurysm after 30 Years

“…Most patients presented between 2 and 5 years after the initial operation and were treated with open repair. Furthermore, only 12.6% of patients presented after 10 years [10].…”

“…The timeframe for development of anastomotic pseudoaneurysms varies based on study but is reported between 5 and 9.2 years after primary operation [7, 10]. Skourtis et al in their case series of 49 patients with anastomotic pseudoaneurysms reported that mean time of pseudoaneurysm developed to be 6.8 years [2].…”