title: Pseudoaneurysm of graft-graft anastomosis of a hand-sewn branched graft: a case report.
abstract: BACKGROUND
  Pseudoaneurysm of graft-graft anastomosis is an extremely rare but potentially fatal complication after thoracic aorta replacement with a prosthetic graft. We report a case of pseudoaneurysm at the graft-graft anastomosis of a hand-sewn branched graft.
  
  
  METHODS
  A 65-year-old man underwent total arch replacement with a hand-sewn branched graft for Stanford type A acute aortic dissection 22 years ago. During follow-up, serial CT scans showed a pseudoaneurysm on the branched graft which warranted reintervention. Surgical repair involved direct suture of multiple bleeding points which were found at the sites of the hand-sewn branches anastomosis. The postoperative course was uneventful, and no signs of bleeding were observed by CT after the reoperation.
  
  
  CONCLUSIONS
  Long-term follow-up is essential to detect late complications at the site of hand-sewn anastomosis.
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan. gomit@shinshu-u.ac.jp.
authors.forename: Toshihito
authors.initials: T
authors.lastname: Gomibuchi
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan. ttakano-ths@umin.ac.jp.
authors.forename: Tamaki
authors.initials: T
authors.lastname: Takano
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan. aruko@shinshu-u.ac.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Wada
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan. mayflyt@shinshu-u.ac.jp.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Terasaki
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan. seto@shinshu-u.ac.jp.
authors.forename: Tatsuichiro
authors.initials: T
authors.lastname: Seto
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan. dfukui@shinshu-u.ac.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fukui
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D000784:Aortic Dissection / Q000175:diagnosis* / Q000601:surgery; D017541:Aneurysm, False / Q000175:diagnosis* / Q000601:surgery; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D012086:Reoperation; D013537:Sutures; D014057:Tomography, X-Ray Computed