Cervantes Monteil F, Melliere D, Becquemin J P
Service de Chirurgie Vasculaire, CHU Henri-Mondor, Université Paris-Val-de-Marne, Créteil.
Chirurgie. 1993;119(9):511-4; discussion 514-5.
This retrospective study was conducted to evaluate the long-term results obtained after treating anastomotic false aneurysm occurring after implantations of aorto-iliac or aorto-femoral prostheses in order to identify optimal treatment. During a 20-year period, 66 anastomotic aneurysms were discovered and treated in 48 patients. The mean delay after initial surgery was 6.3 years. Locations observed were femoral (n = 58) aortic (n = 6) and iliac (n = 2). Five aneurysms were revealed by an acute ischaemia, three others by bleeding and one by abdominal pain. The 57 others were diagnosed in an equal proportion either during physical examination or periodic imaging. Aortic and iliac aneurysms were treated by complete or partial replacement of the prosthesis. There were two urinary fistulas, one being fatal and one recurrent haemorrhage followed by death. Femoral aneurysms were treated in 4 out of 5 cases by interpositioning a prosthesis and in 1 out of 5 cases by simple resuturing. There was one fatal cerebral haemorrhage, 4 cases of early thrombosis and 6 cases, of recurrent anastomotic aneurysm (10%). The clinical course required amputation in 3 patients. In this series, the overall outcome was satisfactory. For aneurysms of aortic or iliac anastomoses, one must avoid dissecting the prosthesis-ureter crossover and blind extraction of a branch which can lead to urinary fistulas. For femoral anastomoses, the following recommendations are important: conservation of the collaterals, suturing deeply into healthy tissue and interposition of a new prosthesis in case of tension. Cases of recurrent aneurysm are rare and should be treated with the same careful procedures.
本回顾性研究旨在评估主动脉-髂动脉或主动脉-股动脉假体植入术后发生的吻合口假性动脉瘤的治疗效果，以确定最佳治疗方法。在20年期间，共发现66例吻合口动脉瘤，并对48例患者进行了治疗。初次手术后的平均延迟时间为6.3年。观察到的部位有股部（n = 58）、主动脉（n = 6）和髂部（n = 2）。5例动脉瘤由急性缺血发现，另外3例由出血发现，1例由腹痛发现。其余57例在体格检查或定期影像学检查中被诊断出的比例相同。主动脉和髂动脉瘤采用假体完全或部分置换治疗。发生了2例尿瘘，1例死亡，1例复发出血后死亡。5例股动脉瘤中，4例采用假体置入治疗，1例采用单纯缝合治疗。发生1例致命性脑出血、4例早期血栓形成和6例复发性吻合口动脉瘤（10%）。3例患者的临床病程需要截肢。在本系列中，总体结果令人满意。对于主动脉或髂动脉吻合口的动脉瘤，必须避免解剖假体-输尿管交叉处和盲目取出分支，以免导致尿瘘。对于股动脉吻合口，以下建议很重要：保留侧支、深层缝合至健康组织以及在有张力时置入新的假体。复发性动脉瘤病例罕见，应采用同样谨慎的方法治疗。
