[Anastomotic aneurysm following insertion of aorto-iliac or aorto-femoral prosthesis. Treatment and long-term results].
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.
Cervantes Monteil
F
F
Service de Chirurgie Vasculaire, CHU Henri-Mondor, Université Paris-Val-de-Marne, Créteil.
Melliere
D
D
Becquemin
J P
JP
D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000209:etiology* / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
Anévrismes anastomotiques après prothèse aorto-iliaque ou aorto-fémorale. Traitement et résultats à long terme.