Baldwin D, Mashbari H, Chow K L, Sarhan M
Department of General Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Department of General Surgery, Jazan University, Saudi Arabia.
Case Rep Vasc Med. 2019 Jul 22;2019:1679214. doi: 10.1155/2019/1679214. eCollection 2019.
Anastomotic pseudoaneurysms are a complication of vascular reconstructive surgery with the majority in the femoral region. Although rare, ruptured femoral anastomotic pseudoaneurysms have high mortality and require emergency surgery.
A 60-year-old male with a history of a left leg crush injury was treated with a superficial femoral artery interposition vein graft 30 years ago. He presented nowadays with a three-day history of severe pain in his left thigh. CT angiography demonstrated a ruptured anastomotic pseudoaneurysm with contrast extravasation into an intramuscular hematoma. He had significant scarring from his previous surgeries which made the leg hostile for an open repair. Therefore, percutaneous access selectively cannulated the left iliofemoral vasculature. An angiogram showed a distal superficial femoral artery pseudoaneurysm. Subsequently, two 10mmx15cm Viabahn covered stents (Gore & Associates, Flagstaff, AZ) were placed bridging healthy superficial femoral artery. A completion angiogram demonstrated no extravasation into the pseudoaneurysm. The patient recovered and was discharged home two days postoperatively.
Ruptured femoral anastomotic pseudoaneurysms are traditionally repaired with open pseudoaneurysm excision and arterial reconstruction, although endovascular repair has been reported. Furthermore, most femoral anastomotic pseudoaneurysms form less than 10 years after initial operation. We present a unique case of ruptured superficial femoral artery pseudoaneurysm, 30 years after the initial operation. Endovascular stents offer effective treatment for ruptured anastomotic pseudoaneurysms.
吻合口假性动脉瘤是血管重建手术的一种并发症，多数发生在股部区域。虽然罕见，但破裂的股部吻合口假性动脉瘤死亡率很高，需要紧急手术。
一名60岁男性，有左腿挤压伤病史，30年前接受了股浅动脉间置静脉移植术。他现在出现左大腿剧痛3天的症状。CT血管造影显示吻合口假性动脉瘤破裂，造影剂外渗至肌内血肿。他既往手术留下明显瘢痕，使得腿部不利于进行开放修复。因此，经皮穿刺选择性地插管至左髂股血管系统。血管造影显示股浅动脉远端假性动脉瘤。随后，置入两枚10mm×15cm的Viabahn覆膜支架（戈尔公司，弗拉格斯塔夫，亚利桑那州）跨越健康的股浅动脉。完成血管造影显示无造影剂外渗至假性动脉瘤内。患者康复，术后两天出院。
传统上，破裂的股部吻合口假性动脉瘤通过开放的假性动脉瘤切除术和动脉重建进行修复，尽管也有血管腔内修复的报道。此外，大多数股部吻合口假性动脉瘤在初次手术后不到10年形成。我们报告了一例初次手术后30年出现的股浅动脉假性动脉瘤破裂的独特病例。血管腔内支架为破裂的吻合口假性动脉瘤提供了有效的治疗方法。
