Cor Vasa 2021, 63(3):378-381 | DOI: 10.33678/cor.2020.108

Giant Pseudoaneurysm in Distal Anastomosis of Prosthetic Aorto-Femoral Bypass

Róbert Novotný^a, Tomáš Marada^a, Michal Kudla^a, Květoslav Lipár^a, Jakub Křístek^{a, b}, Jiří Novotný^c, Jiří Froněk^{a, b}, Libor Janoušek^{a, d}

^a Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague

^b Department of Anatomy, Second Faculty of Medicine, Charles University, Prague

^c Department of Radiology, Charles University, Prague

^d First Faculty of Medicine, Charles University, Prague

Introduction: Anastomotic pseudoaneurysms (APSA) are late complications of vascular reconstructions. The precise prevalence of APSA is not known, as many cases are not published in the literature. However, the rupture of APSA is associated with high morbidity and mortality.

Method: The procedure was performed under full anesthesia. An incision was made in the left groin resect- ing the necrotic skin above APSA. APSA was carefully dissected, confirming the CT angiography finding of a massive thrombosed APSA arising from the distal anastomosis of the aorto-femoral bypass (AFB). The APSA was fully resected. An extension of the AFB with the use of prosthetic vascular graft was performed. The common femoral artery was ligated below the inguinal ligament. Necrotic skin from the groin was resected, and the wound was closed with a patent vascular reconstruction.

Results: The patient was discharged on the 7th postoperative day with low infection's parameters. Currently we have eleven months of follow-up on the patient. The patient has a patent vascular reconstruction with- out any signs of anastomotic APSA on Doppler's ultrasonography.

Conclusion: The most frequent site of APSA occurrence after AFB is the femoral region. Endovascular treat- ment can be used only in very selected cases with a very high risk of complications related to the endovascular devices.

Keywords: Anastomotic, Aortofemoral bypass, Late complication, Pseudoaneurysm

Received: October 27, 2020; Revised: November 12, 2020; Accepted: November 17, 2020; Published: July 20, 2021  Show citation