Marković Dragan M, Davidović Lazar B, Kostić Dusan M, Maksimović Zivan V, Cinara Ilijas S, Cvetković Slobodan D, Marković Miroslav D, Dragas Marko V
Srp Arh Celok Lek. 2006 Mar-Apr;134(3-4):114-21. doi: 10.2298/sarh0604114m.
Anastomotic pseudoaneurysm is a form of false aneurysm, whose wall does not consist of all normal layers of arterial wall. Given the rising number of reconstructive vascular procedures, the increase of anastomotic pseudoaneurysm cases is expected. Therefore, identification of causes, clinical manifestations as well as factors which affect the outcome of operative treatment of anastomotic pseudoaneurysms is of great practical value. This retrospectively-prospective study included 87 surgically treated cases of anastomotic pseudoaneurysms in the period from 1991 to 2002. The most often localization of anastomotic pseudoaneurysms was the inguinal region (68-86.2%). In the majority of cases, they were caused by arterial degeneration in the anastomotic region--56 cases (65.9%) and infection--21 cases (24.7%). The most frequent manifestations of anastomotic pseudoaneurysms were bleeding due to rupture in 26 cases (29.9%) and chronic limb ischaemia in 22 cases (25.3%). An acute limb ischaemia was present in 17 cases (19.5%), the symptoms caused by local compression to the surrounding structures--in 9 cases (10.3%), and in 12 cases (13.8%), the only manifestation of anastomotic pseudoaneurysm was asymptomatic pulsatile mass. In 32 cases (36.8%), surgical treatment involved the resection of anastomotic pseudoaneurysm and graft interposition, whereas in 39 cases (44.8%), bypass procedure had to be performed after the resection. Comorbidity significantly increased mortality in the first 30 days. The use of Dacron graft in primary operation significantly improved early results of operative treatment. Absence of infection as the cause of anastomotic pseudoaneurysm is a statistically important prognostic factor of operative treatment, considering the graft patency, limb salvage, infection, need for reintervention and mortality.
吻合口假性动脉瘤是假性动脉瘤的一种形式，其壁并非由动脉壁的所有正常层组成。鉴于重建性血管手术数量的增加，吻合口假性动脉瘤病例预计也会增多。因此，明确吻合口假性动脉瘤的病因、临床表现以及影响其手术治疗结果的因素具有重要的实际意义。这项回顾性-前瞻性研究纳入了1991年至2002年期间接受手术治疗的87例吻合口假性动脉瘤病例。吻合口假性动脉瘤最常见的部位是腹股沟区（68 - 86.2%）。在大多数病例中，它们是由吻合口区的动脉退变引起的——56例（65.9%），以及感染——21例（24.7%）。吻合口假性动脉瘤最常见的表现是破裂出血26例（29.9%）和慢性肢体缺血22例（25.3%）。急性肢体缺血17例（19.5%），局部压迫周围结构引起的症状9例（10.3%），12例（13.8%）吻合口假性动脉瘤的唯一表现是无症状搏动性肿块。32例（36.8%）手术治疗包括切除吻合口假性动脉瘤并植入移植物，而39例（44.8%）在切除后必须进行旁路手术。合并症显著增加了术后30天内的死亡率。在初次手术中使用涤纶移植物显著改善了手术治疗的早期结果。考虑到移植物通畅率、肢体保全、感染、再次干预需求和死亡率，无感染作为吻合口假性动脉瘤的病因是手术治疗的一个具有统计学意义的预后因素。
