The role of omentopexy in the prevention of femoral anastomotic aneurysm.

In our experience the incidence of anastomotic aneurysms (AA) after prosthetic bypass varied from 0.3 to 0.7% depending on location; it was 5 times higher at aortobifemoral anastomoses (77/3146; 2.44%) than aortic anastomosis (8/2173; 0.37%) (p less than 0.005). In the inguinal region the incidence of femoral AA (FAA) is the same as elsewhere when the prosthesis is placed in front of the inguinal ligament (axillo-femoral anastomoses, 1/200; 0.5%; femoro-femoral anastomoses 1/270; 0.37%). However when the prosthesis is placed behind the ligament, the incidence of FAA rises to 2.44% (77/3746). In our opinion, this difference is due to adherence between the prosthesis and the ligament during hip movement. When the hip is in extension, tension is placed on the prosthesis and the adjacent arterial junction causing the wall of the artery to tear. The sutures almost always remain intact. In an effort to avoid this problem, we have developed a technique that consists of enlarging the passage of the prosthesis by partial section of the inguinal ligament and then wrapping the prosthesis with a free non pedunculated segment of omentum from above the femoral anastomosis down to the healthy segment of the femoral artery which, being elastic, can stretch. The omentum acts as sheath that reinforces the anastomosis. To evaluate this technique we assessed our patients operated upon for aortobifemoral (or aortofemoroiliac) bypass into two groups. Group A included 115 patients operated on by the same surgeon using the new technique (October 1981 and December 1984). There were 111 men and 4 women (mean age: 59.7 years). Mean follow-up was 7.36 years.(ABSTRACT TRUNCATED AT 250 WORDS)