Anastomotic Arterial Aneurysms

Summary

The incidence, pathogenesis, location, management and prevention of false anastomotic aneurysms are reported.

Hundred seventy-six false anastomotic aneurysms in 105 patients were treated in a group of 5,798 patients, who underwent 6,104 reconstructive vascular operations of the aortoiliac and femoro-popliteal area for chronic occlusive arterial disease or atherosclerotic aneurysms between 1966 and 1981 (16 years). The overall patient incidence was 1.8%, the incidence concerning all operations 2.9%. Endarterectomized patients had an incidence of false suture line disruptions of 0.2%, while disruption following prosthetic bypass was 0.9% at the aortic site, 1.1% at the iliac and 5.1% at the common femoral site. After autogenous saphenous vein bypass this complication occurred in 1.3% of the cases. Expanded PTFE grafts (3.2%) and heterogenic bovine grafts (6.0%) showed a similar rate.

Of these false aneurysms 18.8% were infected, 5 aorto-intestina! fistulas had to be treated. Fragmentation of the suture material was found to be the cause of the suture dehiscence in 8%, frayed graft material in 13, 3%, tearout of the host artery in 34%. The time of onset of false aneurysms varied bin predominantly occurred within one year (16%) and between the 4th and 10th year (61%), but even as late as 15 and 20 years after operation. End-to-end anastomosis had a less frequent complication rate (1.2%) than end-to-side anastomosis (3.2%). Recurrence was seen in 20 patients, once as many as 9 times. The treatment of choice is resection and graft interposition. Preventive measures should include the use of Dacron double velour grafts of sufficient diameter inserted without tension, avoidance of endarterectomy at the anastomotic site, tissue coverage of anastomosis and graft, suturing with large stitches, perioperative antibiotic prophylaxis, and frequent follow-up.

Key words

Anastomotic aneurysms - Incidence - Pathogenesis - Management - Prevention