[False anastomotic aneurysms after aorto-femoral prosthesis. Detection, prevention and treatment].

OBJECTIVE

The aim of this study was to evaluate screening, prevention and treatment of false anastomotic aneurysms (FAA).

METHOD

A retrospective analysis of 95 FAA observed in 72 patients (67 males, 5 females, age range 48 to 93 years was conducted. Mean delay to onset was 7.5 years.

RESULTS

Diagnosis was made on the basis of imaging evidence using, since 1978, duplex-scan: 8/15 FAA of the aorta, 4/5 FAA of the iliac arteries and 35/75 FAA of the femoral arteries. Treatment was always difficult due to atherosclerosis. The greatest difficulties were encountered in aortic FAA with 1 death due to septic rupture, 1 nephrectomy by ureteral fistula and 1 graft sepsis successfully treated with an allograft. There were 2 deaths in the iliac FAA, 1 due to ureteral fistula and 1 due to heart failure. For femoral FAA, there were 3 deaths (cerebral hemorrhage, graft sepsis and renal failure after acute aortic thrombosis). Long term results showed 6 recurrent femoral FAA which were reoperated successfully.

CONCLUSION

FAA complicates 2 to 5% of graft procedures and can lead to death and amputations: 1.) Clinical surveillance and regular duplex-scan examinations are essential: the diagnosis should also be entertained in case of digestive hemorrhage. 2.) The threshold of dilatation which suggests the need for surgical repair would appear to be a two-fold dilatation but for the aorta, localized dehiscence requires surgery. 3.) A graft procedure is usually used, stents can by used for end-to-end aortic or iliac anastomoses. 4.) Since FAA remains a risk after graft, revascularization should be entertained when other methods have failed. 5.) Patients should be informed of the risk and of movements to avoid in case of femoral anastomoses and also of required regular checkups.