Large Non-anastomotic False Aneurysm on Dacron Aortobifemoral Prosthesis Solved by Endovascular Exclusion

Abstract

Aortic and iliac pseudo-aneurysms are infrequent but challenging complications after open surgical graft reconstructions, mostly having para-anastomotic localisations. The true corporeal peri-prosthetic false aneurysms are, up until now, very rarely documented presentations. We report the clinical case of an 8.8 cm diameter non-anastomotic and aseptic pseudo-aneurysm developed on aorto-bifemoral Dacron prosthesis in a symptomatic and high surgical risk patient. Considering the clinical presentation and the anatomical features, a chronic tear of the posterior prosthetic wall by prominent aortic remnant calcifications was evoked as the possible aetiology. An endovascular exclusion, using a tapered aorto-uni-iliac endograft coupled to a femoro-femoral bypass revascularisation, was technically successful. Despite scarce published clinical data focusing on the optimal treatment dedicated to this category of false aneurysm, this approach is thought to be beneficial in selected cases of high-risk surgical patients.

Endovascular Repair of Isolated Iliac Artery Aneurysms

“…6,9 Para-anastomotic aneurysm is an infrequent but challenging complication after open surgical graft reconstruction. 3,[18][19][20] Continuous expansion may lead to rupture, which is associated with high mortality (67% to 100%). 19 In our patient population, 22 aneurysms occurred at the anastomotic site after graft placement.…”

“…1 Isolated IAAs are rare, with an estimated prevalence of 0.008% to 0.03%. The most common cause for IAA is atherosclerosis, followed by trauma, infection, and colla-gen diseases, 2 but they may also develop at anastomotic sites after surgical reconstruction for arterial diseases 3,4 or at the proximal and/or distal ends of stent-grafts. 5 More than 65% of IAAs are asymptomatic and are found incidentally.…”

Graft aneurysm as long-term complication of a polyester prosthesis ? short review based on a systematic review of literature

“…The endovascular repair of the aneurysms also provides an elegant and patient-friendly alternative. In the researched cases 2,11 , a Talent ® stent-graft prosthesis (Medtronic, Minneapolis / MN, USA) was used. Offer et al 11 used a 16x130 mm stent-graft, which was placed into the native femoral artery with a 22-Fr.…”

“…The oversizing was calculated with 15%, so the aneurysm was excluded without endo-leak. In the case of Alexandrescu et al 2 , the aneurysm was successfully sealed with a tapered aorto-uni-iliac 24x14 mm stent graft due to an isolation and punctuation of the femoral artery. The type of therapy must certainly be adapted to the condition and comorbidities of the patient.…”

Case Report: False aneurysm as a late unusual complication of the aortofemoral bypass graft in a patient with critical leg ischemic symptoms: interesting case

“…Likewise, it is regarded as a delayed complication of prosthetic reconstructive vascular surgery, occurring at an incidence rate ranging from 2% to 29%. While anastomotic pseudoaneurysm (PSA) is a well-known complication, non-anastomotic localization is exceptionally rare and uncommon ( 4 , 6 ). Various factors contributing to the formation of pseudoaneurysms (PSAs) on prosthetic graft bypass have been documented and theorized in the literature.…”