Salimi Javad, Dahaghin Ghazal, Mousazadeh Siamak, Bighamian Afshin
Department of Vascular Surgery, Sina Hosital, Tehran University of Medical Sciences, Tehran, Iran.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Int J Surg Case Rep. 2025 Aug 14;135:111814. doi: 10.1016/j.ijscr.2025.111814.
Anastomotic aortic pseudoaneurysm is a rare, late, and fatal complication after open surgery to repair an abdominal aneurysm. Treatment can be challenging in complex cases, especially renal and visceral arteries. A common solution is the fenestrated endograft, which has branches that accommodate these vital vessels. Sometimes, due to the position of the pseudoaneurysm and its proximity to visceral arteries, especially renal arteries, open repair would be challenging; therefore, an endovascular approach could be a safer option.
A patient was admitted 10 years after open surgical repair of an abdominal aortic aneurysm. The pseudoaneurysm was successfully treated with a four-fenestration endovascular repair (fEVAR) extending to the previous abdominal tube graft, and the patient recovered well.
Para-anastomotic aortic pseudoaneurysms are rare but challenging, demanding complicated management due to visceral artery involvement. Treatment options include open repair, endovascular techniques (e.g., fEVAR or stent grafts), and minimally invasive approaches such as thrombin injection, with case studies indicating successful results. Still, there is limited evidence available on optimal strategies.
Fenestrated endovascular aortic repair after previous open surgery is associated with low perioperative complications and reasonable medium-term survival rates.
吻合口主动脉假性动脉瘤是腹主动脉瘤开放手术后一种罕见、晚期且致命的并发症。在复杂病例中，尤其是涉及肾动脉和内脏动脉时，治疗颇具挑战性。一种常见的解决方案是开窗型腔内移植物，它带有可容纳这些重要血管的分支。有时，由于假性动脉瘤的位置及其与内脏动脉（尤其是肾动脉）的接近程度，开放修复会很困难；因此，血管腔内治疗方法可能是更安全的选择。
一名患者在腹主动脉瘤开放手术修复10年后入院。通过延伸至先前腹段人工血管的四开窗血管腔内修复术（fEVAR）成功治疗了假性动脉瘤，患者恢复良好。
吻合口周围主动脉假性动脉瘤虽罕见但具有挑战性，因涉及内脏动脉而需要复杂的处理。治疗选择包括开放修复、血管腔内技术（如fEVAR或覆膜支架）以及诸如注射凝血酶等微创方法，病例研究表明这些方法均有成功案例。然而，关于最佳策略的证据仍然有限。
既往开放手术后进行开窗型血管腔内主动脉修复术围手术期并发症发生率低，中期生存率合理。
