Chronic anastomotic pseudoaneurysm on a polytetrafluoroethylene axillobifemoral bypass graft

Abstract

A 70-year-old man presented with a painless pulsatile mass at the right iliac fossa that he had first noticed 2 years earlier. In 2012, a right axillobifemoral bypass graft was performed to treat severe occlusive aortoiliac disease. At that time, the patient had severe chronic obstructive pulmonary disease, severe abdominal obesity, and heavily calcified abdominal aorta that contraindicated aortobifemoral surgery. A 50-cm-long 8-mm ringed polytetrafluoroethylene (PTFE) graft was used from the right axillary to the right femoral artery. Once the axillary anastomosis was completed, the graft was found to be short. A second PTFE graft was therefore added in an end-to-end fashion to reach the femoral artery, followed by a femorofemoral bypass.Physical examination showed no signs of infection, and there was no history of direct trauma to the right iliac fossa. The right and left femoral pulses were present. A computed tomography scan revealed a pseudoaneurysm at the site of the graft-to-graft anastomosis (A).An incision was made directly over the mass. After proximal and distal vascular control, the pseudoaneurysm was incised and showed classic thick fibrous tissue. Complete disruption of the anastomosis was noted, and both ends were 6 to 7 cm apart. An 8-mm PTFE graft was used in an end-to-end fashion. The postoperative course was uneventful. The cultures came back negative. An informed consent was obtained from the patient.

Nonanastamotic Pseudoaneurysm in an axillofemoral bypass graft

“…Most reported cases of AFB graft-associated PSAs are at sites of initial anastomoses; in some instances where the initial graft required elongation (thus, new sites of anastomoses), the PSA developed at that location instead [3]. In contrast, PSA development at the nonanastomatic sites has been documented to be very rare and associated with trauma [4].…”