Anastomotic False Aneurysms Research Articles

Aortic Transgraft Hemorrhage after Systemic Thrombolytic Therapy

Aortic transgraft hemorrhage is an unusual complication following thrombolytic therapy that can occur months to years after aortic surgery. It is critical to differentiate this from other potential causes of hemorrhage, such as an acute bleed from an anastomotic false aneurysm which is a surgical emergency. One such case that was managed conservatively with success is reported.

Infected False Hepatic Artery Aneurysm after Orthotopic Liver Transplantation Treated by Resection and Reno-Hepatic Vein Graft

Vascular complications after liver transplantation are relatively rare. Thrombosis of the host-transplant arterial anastomosis is the most frequently encountered vascular complication whereas only a few observations of infected anastomotic aneurysms, often leading to death by massive bleeding or loss of the transplant, have been reported. We report herein the case of a patient with an infected false anastomotic aneurysm of the hepatic artery associated with dissection of the celiac artery following orthotopic liver transplantation in a 35-year-old man who had received a liver transplantation for end-stage liver disease secondary to posthepatitis cirrhosis in March 1989. Starting at day 30, he had signs of infection associated with hemocultures positive for Staphylococcus aureus. A subhepatic collection was found on sonography and CT scan and also cultured positive for the same germ. Arteriograms demonstrated a celiac artery dissection associated with a false anastomotic aneurysm of the hepatic artery. Surgical treatment consisted of arterial reconstruction using a saphenous vein graft between the right renal artery and the hepatic artery of the transplant, followed by resection of the hepatic artery aneurysm and the celiac artery. Hepatic ischemia was 12 min. The immediate postoperative course was uneventful and postoperative angiograms showed that the reconstruction was patent at 5 years.

The Validity of Current Vascular Imaging Methods in the Evaluation of Aortic Anastomotic Aneurysms Developing After Abdominal Aortic Aneurysm Repair

The aim of this cross-sectional study was to evaluate the validity of current imaging methods for diagnosing anastomotic false aneurysms (AFA) of the aorta. One hundred four patients who had undergone elective abdominal aortic aneurysm repair between January 1, 1985, and May 31, 1991, were studied. All of them were investigated for potential development of an aortic anastomotic aneurysm by B-mode ultrasonography, CT scanning, digital subtraction arteriography, and MRI. These findings were compared with results of color-coded Doppler imaging, which is considered the "gold standard," and were subsequently classified as true positive or true negative. The accuracy of color Doppler ultrasound was independently evaluated by clinical examination of the patients, which was carried out for a mean period of 77.5 months during follow-up. On the basis of the data obtained and observations made during follow-up (mean 36.4 months), the sensitivity and specificity of the preceding imaging methods were estimated. Aortic anastomotic aneurysms were detected in two patients (1.9%). The sensitivity of all methods was 100% and specificity was as follows: 74.2% for ultrasound, 59.8% for nonenhanced CT scans, 85.4% for enhanced CT scans, and 99% for digital subtraction arteriograms. Color Doppler and MRI were 100% specific for ruling out aortic anastomotic aneurysms. In a comparison of the accuracy, estimated cost, safety, and the availability of each method, color Doppler appeared to be the diagnostic method of choice for identifying aortic anastomotic aneurysms after abdominal aortic aneurysm repair.

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. Copyright © 1996 The International Society for Cardiovascular Surgery.

Longitudinal forces acting on a knitted polyester arterial prosthesis when implanted as a thoracic aorta substitute in the dog.

The longitudinal forces under which arterial prostheses are held in situ are of great importance. The tension caused by the longitudinal force may be one of the factors involved in the formation of anastomotic false aneurysms. In order to measure the changes in the longitudinal force at both proximal and distal end-to-end anastomoses over different periods of implantation, we devised an experimental study in which the changes in length of a warp-knitted polyester VP1200K (Vascutek Ltd., Inchinnan, Scotland) arterial prosthesis, used as a thoracic aorta substitute in the dog, were recorded photographically at implantation and removal. The longitudinal forces acting at the two sites were then calculated using a linear relationship between the longitudinal force and the changes in length of a virgin prosthesis, which was found experimentally in vitro using a computerized laser calibration system. One-tailed Student's t-test showed no significant difference between the length indicator values at the two anastomotic sites at different periods of implantation except during the 1-month period. Textile analysis of the explanted prostheses and histopathologic observations confirmed this similar behavior at the two anastomotic sites. These observations were contrary to the theoretic prediction regarding the effect of forces applied by drag and tissue ingrowth. Nevertheless, analysis of variance confirmed that there was no difference evident at the two sites between different implantation periods. These observations may explain why the formation of anastomotic false aneurysms is less common at end-to-end anastomoses.

Aneurysmal change at or above the proximal anastomosis after infrarenal aortic grafting

We conducted a retrospective review of all patients undergoing repair of abdominal aortic aneurysm at or above the proximal anastomosis of a previous infrarenal aortic graft between 1986 and 1991. Infected grafts and patients with suprarenal aneurysms present at the time of the original graft were excluded. Twenty-one patients, 19 men and two women, were included. The original indication for surgery was aneurysm in 14 patients and occlusive disease in seven; the mean interval from initial surgery to presentation was 10 years (range, 3 to 23 years). Twelve lesions were anastomotic false aneurysms, and nine were true aneurysms beginning in the proximal juxtaanastomotic aorta. Fourteen patients had an asymptomatic abdominal mass. Seven patients had symptoms of acute expansion (three), rupture (three), or thrombosis (one). True aneurysm and symptomatic presentation were correlated with aneurysm as the original indication for surgery. Repair was accomplished by an interpositional graft in 13 and graft replacement in eight. Seven patients required suprarenal anastomosis or renal and visceral reconstruction. Five operative deaths (24%) occurred, including two of three patients with rupture (67%) and two of seven patients (28%) in the suprarenal group. The mortality rate for elective repair with an infrarenal anastomosis was 11%. Two additional late deaths occurred during the follow-up period.

Aortic False Aneurysms After Prosthetic Reconstruction of the Infrarenal Aorta

False aneurysm of the infrarenal aorta was found at the site of proximal anastomosis in 13 patients after vascular reconstruction for lower limb arterial disease. The grafts involved were aortoprosthetic in one patient, aortobiiliac in two patients, and aortobifemoral in 10 patients. They had been implanted eight years prior to reoperation on the average (range six months to 15 years). False aneurysm was diagnosed because of abdominal pain in four cases, embolism in two cases, intestinal hemorrhage in one case, and during routine sonographic or computed tomographic (CT) scan surveillance in the six other cases. Femoral false aneurysm was associated in eight of 10 cases with femoral anastomoses. Aortic false aneurysms were repaired by interposition of a prosthetic tube between the infrarenal aorta and the original prosthetic graft in 11 cases and by changing the aortobifemoral graft in two cases. In one further case, repair was accomplished by implanting an aortobifemoral prosthetic graft laterally on a prosthetic tube interposed between the infrarenal aorta and the body of the original prosthetic graft, which continued to irrigate the internal iliac arteries. There was no mortality. Thrombosis of a prosthetic branch occurred in one case and was treated by thrombectomy. One patient underwent reoperation for intestinal obstruction. Two others had distal embolism responsible for toe necrosis. Anastomotic false aneurysms should be looked for routinely during the surveillance of prosthetic grafts implanted on the infrarenal aorta, especially when femoral false aneurysm is found. Preservation of pelvic vascularization must be an integral part of management.

Aortoiliac Surgery and Kidney Transplantation

Between January 1980 and December 1989, we performed 407 renal transplantations. Twelve of these patients (3%) underwent aortoiliac reconstruction before (Group I, two patients), concomitant to (Group II, five patients) or after (Group III, five patients) renal transplantation. The aortoiliac lesions treated included four aneurysms and seven occlusions of the abdominal aorta and one postarteriography dissection of the iliac artery. A prosthetic graft was inserted in nine cases (75%). Endarterectomy was performed in the three other cases (25%). Four of five patients in Group III were operated on without any particular protection for the transplant. There were no postoperative deaths in Groups I and III. In Group II, one patient died of infection secondary to a urinary tract fistula. Early and late vascular morbidity (renal artery stenosis, occlusion of aortoiliac reconstruction, anastomotic false aneurysm) occurred with equal frequency in the three groups. Renal transplantation in patients having already undergone aortoiliac surgery and, conversely, aortoiliac reconstruction in the renal transplant patient, are possible without any particular technical precautions with minimal mortality and kidney morbidity. Simultaneous renal transplantation and aortoiliac reconstruction carries a significant risk of infection and a two-stage procedure should be considered in this situation.

異型大動脈縮窄症バイパス術後の胸部下行大動脈吻合部動脈りゅう破裂症例に対するｔｈｒｏｍｂｏｅｘｃｌｕｓｉｏｎ法の１例

異型大動脈縮窄症バイパス術後の胸部下行大動脈吻合部動脈りゅう破裂症例に対するｔｈｒｏｍｂｏｅｘｃｌｕｓｉｏｎ法の１例

End-to-side Aortoprosthetic Anastomoses: Long-term Computed Tomography Assessment

Fifty-two asymptomatic patients underwent routine computed tomographic evaluation of aortobifemoral bypass grafts implanted end-to-side on the aorta five to 10 years after operation. Anteroposterior diameters were measured at the level of the stem and the limbs of the graft, the aortoprosthetic anastomosis, and the infraanastomotic aorta. The stems of the prostheses were found to be dilated between 30 and 110% (mean 58%) of initial values. The limbs of the graft were dilated between 15 and 150% of initial values, the mean being 52%. The anteroposterior diameter of the aortoprosthetic anastomosis measured between 27 and 48 mm with a mean of 32 mm. Eight patients (15%) had an anastomotic false aneurysm. The aorta distal to the prosthetic anastomosis was completely occluded in 48 cases (92%). A mural thrombus was encountered at the level of the aortoprosthetic anastomosis in 21 (40%) patients. These findings raise questions as to the possible role of side-to-end aortoprosthetic anastomoses in the genesis of anastomotic dilatations, false aneurysms, intraprosthetic thrombosis, and thrombosis of the branches of aortofemoral bifurcation prosthetic grafts.

A Successfully Treated Case of Eeteric-Fistula of Anastomotic False Aneurysm with Gastrointestinal Massive Bleeding

A Successfully Treated Case of Eeteric-Fistula of Anastomotic False Aneurysm with Gastrointestinal Massive Bleeding

Anastomotic false aneurysms of the abdominal aorta and the iliac arteries

Anastomotic false aneurysm (AFA) of the aorta or iliac artery is a potentially lethal complication of prosthetic grafts. To study this complication, the records of 18 patients with 22 noninfected AFAs (15 aortic and seven iliac) were reviewed. Patients with an intact AFA had a pulsatile abdominal mass, abdominal pain, an occluded graft, peripheral emboli, or a femoral anastomotic false aneurysm. All patients with a ruptured AFA were in shock, but 67% (four of six) had symptoms before hemorrhage. For diagnosis, single-plane angiography was 69% accurate (11 of 16), computed tomography was 100% accurate (six of six), and ultrasound was used once and suggested an AFA. Three patients with an AFA less than 5 cm diameter were initially observed; however, all three aneurysms rapidly enlarged and one ruptured. The operative mortality rate was 8% (1 of 12) for patients with an intact aneurysm and 67% (four of six) for patients with a ruptured aneurysm. Treatment was resection of the AFA and replacement with a new graft. Retroperitoneal AFAs often appear years after the initial operation, and life-long follow-up is required for patients with an aortic or iliac graft. All retroperitoneal AFAs should be resected since the outcome of patients with a ruptured AFA is poor.

Anastomotic false aneurysms of the abdominal aorta and the iliac arteries

Anastomotic false aneurysms of the abdominal aorta and the iliac arteries

Femoral false aneurysms: a recommendation for the method of repair.

False aneurysm formation is a major complication of vascular surgery. The most frequent site of anastomotic false aneurysm formation is the femoral artery. Between January 1974 and June 1986, 26 patients with 42 femoral false aneurysms were treated at the Princess Alexandra Hospital. Aneurysms developed following Dacron arterial grafting (29 aneurysms), saphenous vein grafting (10 aneurysms), umbilical vein grafting (one aneurysm) and femoral embolectomy (two aneurysms). Arterial wall failure (with intact suture and graft) was the most frequent operative finding. Ten recurrent aneurysms developed. There was a significantly greater number of recurrences when resuture or patch repair was employed than when an interposition graft was used as a repair. The development of a femoral anastomotic false aneurysm should be viewed as a total failure of that anastomosis and repair should be by replacement with an interposition graft rather than repair of the failed anastomosis by suture or patch.

Traumatic Pseudoaneurysm in an In-Situ Femoro-Popliteal Bypass Graft — A Case Report

Anastomotic false aneurysm is a commonly reported complication of bypass surgery, but blunt trauma has been a rare etiologic mechanism. An unusual case of a traumatic false aneurysm arising in the distal anastomosis of an in-situ femoro-popliteal bypass graft is presented and the pathophysiology of the entity is discussed.

Early vascular grafting to prevent upper extremity necrosis after electrical burns: Anastomotic false aneurysm, a severe complication

From May 1972 to January 1982, early vascular grafting was used to re-establish circulation across the electrically burned wrist. Thirty-three thrombosed arterial segments (radial and/or ulnar arteries) were removed in 18 limbs and autografts of the greater saphenous or omental veins were used for the revascularization. One vascular graft, which had been sutured to the ulnar artery on day 3 post-injury, contained an anastomotic false aneurysm at the proximal anastomosis. One month after vascular grafting, this aneurysm ruptured and bled. An emergency exploration of the wrist confirmed the diagnosis and surgery successfully restored the circulation, avoiding amputation of the injured limb. Histopathological examination of the specimen was consistent with the presence of anastomotic false aneurysm. The pathogenesis of this complication is reviewed. Our experience indicates that circulation to a limb following electrical injury can be successfully restored by early vascular grafting, but emphasizes the importance of close periodical follow-up after graft acceptance due to the possibility of late anastomotic complications.

Reoperation for femoral anastomotic false aneurysm. A 15-year experience.

An experience on the surgical treatment of anastomotic false aneurysms during the last 15 years was reviewed. Fifty-nine were femoral anastomoses complicated by false aneurysm appearance requiring surgical excision. They represented 2.9% of all femoral anastomoses performed, whereas they represented 3.3% when considering reconstruction in which the femoral artery was the distal anastomosis. Reconstructions with distal anastomosis performed on the femoral artery were primarily involved (58 of 59), whereas grafts with "take off" from the femoral artery were rarely affected (p less than 0.05). A higher incidence of false aneurysm formation was demonstrated in hypertensive patients (p less than 0.05) as well as those who previously had femoral thromboendarterectomy (p less than 0.01). Infection was considered a causative factor even if it developed before (6-14 months) false aneurysm appearance. When a false aneurysm was resected, the best hemodynamic reconstruction, to avoid recurrence, was considered a bypass with distal anastomosis performed end-to-end on the femoral artery (p less than 0.05). The surgical treatment of choice was false aneurysm resection and graft interposition. However, a reanastomosis in the presence of small false aneurysms, when technically possible, has been successfully performed. Both treatments allowed good long-term results.

Anastomotic False Aneurysms with Aortic Dacron Graft after Twenty-Five Years

Anastomotic False Aneurysms with Aortic Dacron Graft after Twenty-Five Years

Extended use of computed tomography in the management of complex aortic problems: A learning experience

Eighty-nine patients with clinical problems arising from the thoracic or abdominal aorta had computed tomography (CT) scans with contrast enhancement in addition to standard aortograms. Forty-four patients had aneurysms, 22 had aortic graft complications, and 23 had aortoiliac occlusion. CT scanning provided diagnostic information not apparent by conventional angiography in 39 patients (43.8%). This additional information did not significantly alter the operative management in 13 patients (14.6%). The helpful information provided by CT in these patients included demonstration of gallstones, renal cysts, anomalous venous structures, horseshoe kidney, and femoral anastomotic aneurysms. However, in 26 of 89 patients (29%), the additional data obtained by CT significantly changed the timing or approach to operative management. Management was altered in 12 of 44 patients (28%) with aneurysms, 7 of 22 patients (32%) with aortic graft complications, and 7 of 23 patients (30%) with aortoiliac occlusive disease or suspected distal thromboembolism. Specific information provided by CT included contained aortic aneurysm rupture, aortic dissection, laminated intraluminal thrombus or pseudointima, extent of perigraft infection, aortic atherosclerosis, anastomotic false aneurysm, and thrombus as a source of distal embolization. Thus, CT had a significant impact on operative management. It serves as a valuable adjunct to aortography in patients with complex aortic problems.

Late False Aneurysm Following Replacement of Ascending Aorta: The Problem of the Teflon Graft in Combination with a Silk Suture Anastomosis

Two patients underwent resection and replacement of the ascending aorta using a low-porosity Teflon graft anastomosed with silk suture. In both patients false aneurysms developed that required operation 13 and 23 years postoperatively. The clinical courses of these patients, along with data from the literature, suggest that the combination of a low-porosity Teflon graft and a silk suture anastomosis presents a major potential hazard for the development of anastomotic false aneurysm.