Anastomotic pseudoaneurysms. A continuing late complication of vascular reconstructive procedures
J. W. Dennis, F. N. Littooy, H. P. Greisler and W. H. Baker
Anastomotic pseudoaneurysms continue to be a late complication of vascular
grafting procedures. We reviewed the records of 48 patients who presented
with 65 abdominal or lower extremity anastomotic pseudoaneurysms during
1977 to 1985. The interval between the original operation and the
development of a pseudoaneurysm was 6.2 years (range, 2.5 months to 19
years). Most patients underwent resection of the involved segment of graft
and artery with placement of an interposition graft. Graft patency was
97.5% during a mean follow-up of 2.4 years (range, two months to five
years), and one operative mortality occurred. Four patients had emergency
procedures; one patient underwent reconstruction, and three others
underwent resection of the pseudoaneurysms alone. Two of those patients
died, and the one survivor eventually required a high amputation. We
recommend aggressive diagnosis and surgical reconstruction in these
patients usually by interposition grafts or anastomotic revisions because
the short- and long-term results are excellent. Morbidity and mortality are
greatly increased when these procedures are done emergently.
