Thrombotic obstruction of a reinforced ringed expanded polytetrafluoroethylene graft caused by formation of a pseudoaneurysm at a nonanastomotic site: report of a case.

We report herein the case of a 72-year-old man in whom a nonanastomotic pseudoaneurysm arose from a reinforced ringed expanded polytetrafluoroethylene (EPTFE) graft (Gore-Tex, Flagstaff, AZ, USA) following an axillobifemoral bypass. The pseudoaneurysm developed 2 years after graft insertion and induced graft thrombosis. The development of the pseudoaneurysm can be attributed to the fact that his axillobifemoral bypass graft was so short it deformed the proximal anastomosis, and the graft was subcutaneously tunneled onto the major pectoral muscle. These technical errors placed the graft under too much tension in the longitudinal direction, which resulted in graft disruption and pseudoaneurysmal formation, followed by thrombosis of the axillary artery. Moreover, the possibility of direct trauma at the time of insertion cannot be substantiated. Although the very poor compliance and design of the externally supported ring could not tolerate stretch deformity in the Gore-Tex graft, only one other case of a nonanastomotic pseudoaneurysm has ever been reported.