title: Predictors of development of anastomotic femoral pseudoaneurysms after aortobifemoral reconstruction for abdominal aortic aneurysm.
abstract: BACKGROUND
  The pathogenesis of anastomotic femoral pseudoaneurysms (AFPs) is still unclear. We have performed this long-term retrospective study of patients who underwent aortobifemoral reconstruction for abdominal aortic aneurysm (AAA) in order to better establish the long-term rate of AFP and to identify the predictors of its late occurrence.
  
  
  METHODS
  The long-term outcome of 178 patients who underwent and survived aortobifemoral reconstruction for infrarenal AAA was reviewed.
  
  
  RESULTS
  During a median follow-up of 5.2 years, 28 AFPs developed in 19 patients. Six AFPs were recurrent. The mean linearized rate of AFPs was 1.88% per year. At 15 years, the survival-freedom rate from AFPs was 60%, and from repair of AFPs it was 62%. The survival-freedom rate from AFP was significantly poorer in patients with chronic obstructive pulmonary disease (P = 0.017; at 10 years: 64.3% versus 92.3%), hyperlipidemia (P = 0.0056; at 10 years: 59.2% versus 87.5%), current smoking (P <0.0001; at 10 years: 65.8% versus 94.5%), and postoperative inguinal wound infection (P <0.0001; at 10 years: 42.8% versus 86.8%). Multivariate analysis showed that chronic obstructive pulmonary disease (relative risk [RR]: 3.05, 95% confidence interval [CI]: 1.04 to 8.95), current smoking (RR: 5.38, 95% CI: 1.62 to 17.90), and postoperative inguinal wound infection (RR: 9.04, 95% CI: 2.76 to 29.96) were significantly associated with the development of AFPs. The linearized rate of AFPs was significantly higher only among current smokers (P <0.0001, 4.4% versus 0.8% per year) and among those who had inguinal wound infection (P = 0.001, 9.2% versus 1.5% per year).
  
  
  CONCLUSIONS
  Current smoking and inguinal wound infection may contribute to the development of AFP after aortobifemoral reconstruction for AAA, likely by affecting reparative connective tissue mechanisms at the anastomotic site.
authors.affiliation: Department of Surgery, Division of Cardiothoracic and Vascular Surgery, University of Oulu, P.O. Box 21, 90029 Oulu, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Ylönen
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Enrico
authors.initials: E
authors.lastname: Leo
authors.forename: Pekka
authors.initials: P
authors.lastname: Rainio
authors.forename: Esa
authors.initials: E
authors.lastname: Salmela
authors.forename: Jarmo
authors.initials: J
authors.lastname: Lahtinen
authors.forename: Jari
authors.initials: J
authors.lastname: Satta
authors.forename: Risto
authors.initials: R
authors.lastname: Pokela
authors.forename: Martti
authors.initials: M
authors.lastname: Lepojärvi
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects*; D017541:Aneurysm, False / Q000209:etiology*; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000009:adverse effects