False aneurysms occurring after arterial grafting operations

Treatment of Arterial Occlusive Disease of the Lower Extremities

“…The incidence of graft infection was, however, minimized with the advent of routine perioperative antibiotics, and with improved bioprosthetic design, which allows earlier and more complete tissue incorporation (3,14,20,35,38). It has also been suggested that the more common use of an end-to-end proximal anastomosis, as opposed to end-to-side, contributes to a substantial reduction in the formation of proximal pseudoaneurysms and secondary aortoenteric fistulae (17,36). Not only does the end-to-end anastomosis provide a less turbulent hemodynamic flow pattern, but it also allows more adequate closure of the retroperitoneal tissue over the proximal suture line, thereby protecting it from the overlying bowel.…”

False Aneurysms

“…Claytor and associates, in 1956, reported the first case of anastomotic aneurysm in a patient after prosthetic aortic graft placement [45]. Although silk was used as a suture material for anastomosis (prior to 1967), the most frequent cause of FAA was breaking of the suture material [47][48][49][50][51][52][53][54]. Introduction of synthetic polyfilament suture materials has significantly decreased this cause.…”

“…In his discussion of the Stoney and Albo study [47], Baker suggested that anastomosis in the femoral region must be covered by a mobilized sartorius muscle to decrease stress. Mechanical stress caused by insufficient graft length [50] or configuration of end-to-side anastomosis [47,56,66] and the mechanical stress caused by an extensive mismatch, occurring if the prosthesis is too rigid, are also described. With every pulse wave, the anastomotic part of the artery is dilated at least 10% more than the prosthesis.…”

Nahtaneurysmen als Sp�tkomplikation gef��rekonstruktiver Eingriffe an der unteren Extremit�t

“…Ihre Incidenz betragt 0,5 bis 4,8 ~ [6,11,12], im eigenen Patientengut 0,7}/0. Frfihere Ver6ffentlichungen berichten fiber 23,7~ [10], wobei sich diese Angaben auf ein Operationsgut beziehen, bei dem noch Seide (Resorptionszeit 4Jahre) als Nahtmaterial verwendet wurde.…”

“…Ftir die Pseudoaneurysmaentstehung werden eine Reihe Faktoren diskutiert: Es sind dies, abgesehen von der nicht mehr gebr~iuchlichen Seide als Nahtmaterial [5,10], Nahtbruch yon Polypropylenefaden [2,5], Durchschneiden der Naht in der Gef'aBwand, wechselnde Spannung bei Bewegung im Gelenksbereich [5], Endarteriektomie der AnschlugsteUen [9], Turbulenzen und Auftreten von Scherkr~if-ten bei End-Seit-Anastomosen [5,9,11], Ausfransen der (gewebten) Prothese, Degeneration der Empfangerarterie [1], Anastomose unter zu starker Spannung, Hypertonie [9,11], frfihzeitige Anticoagulation, Wundheilungsst6rung [11] und Infektion [5]. Andere Autoren machen hauptsachlich eine Ursache ftir die Entwicklung von Nahtaneurysmen verantwortlich:…”