Open access peer-reviewed chapter

False Aneurysms

Written By

Igor Banzić, Lazar Davidović, Oliver Radmili, Igor Končar, Nikola Ilić and Miroslav Marković

Submitted: December 11th, 2011 Reviewed: May 11th, 2012 Published: August 29th, 2012

DOI: 10.5772/48656

Chapter metrics overview

2,362 Chapter Downloads

View Full Metrics

1. Introduction

Although great strides have been made in vascular and endovascular surgery in last decade, still remains challenge to resolve problems with false aneurysm or pseudoaneurysm. This problem is especially connected to sites that are managing vascular patients mostly with open surgical treatment.

Advertisement

2. Definition

All aneurysms can be classified by location, size, shape and etiology. However, there is always significant confusion about what a false aneurysm or pseudoaneurysm is. True aneurysm presents with all three layers of arterial wall. Pseudoaneurysm or false aneurysm occurs as result of blood flow outside the normal layers of the arterial wall. Basically blood is going through the hole in the wall of artery into contained space outside. That blood is compressed by surrounding tissue so it finally reenters the artery during the cardiac cycle. Repeating this process, false aneurysm (outside the artery) begins to grow.

False aneurysm could be caused by trauma, infections, iatrogenic or every kind of conditions that could promote focal weakness within the arterial wall.

Advertisement

3. False traumatic aneurysms (FTA)

The management of FTA of arteries has a long history. One of the earliest texts known, the Ebers Papyrus (2000 BC), contains a description of FTA of the peripheral arteries [1]. During the second century AD; Antyllus treated FTA by applying a ligature above and below the lesion, incising the aneurysmal sac, and extracting the clot. In 1873 Pick provided an interesting and detailed account on his management of an FTA of a large femoral artery by digital compression, which had an unsatisfactory final result [1]. The first reported FTA repair was by Matas in 1888. He operated on a young male patient with a large FTA of the brachial artery that had developed after multiple gunshots [2]. After ligation of the main proximal and distal arteries, he opened the aneurysm sac and sutured all collaterals with back-bleeding. Fifteen years later, Matas described this procedure as a reconstructive endoaneurysmorrhaphy [3]. Vojislav Soubbotich, a Serbian surgeon treated 60 FTA and 17 traumatic arteriovenosum fistulas (TAVF) during the Balkan wars between 1912 and 1913. He performed some of the reconstructive procedures in 32 cases [4]. Rich published an interesting article titled, ‘‘Matas Soubottich Connection.’’ He said that Soubbotich’s technique and results had been outrun 40 years later, during the Korean conflict [5].

Advertisement

4. Incidence

It is difficult to determine the true incidence of FTA. Some series combine iatrogenic with traumatic lesions. During World War II Elkin and Shumacker noted that there were 558 (22.58%) FTA and TAVF among the total 2471 vascular injuries [6]. According to Hughes and Jahnke’s data, 215 cases of TAVF and FTA were described during the Korean conflict [7]. The largest series of surgically treated combat-related vascular injuries of about 1000 cases was published by Rich after the Vietnam war. They included 558 (incidence 55.8%) TAVF and FTA [8]. The first large civilian series of traumatic AVF and false aneurysms were published by Pattman et al. in 1964 [9], and Hewitt et al. in 1973 [10]. The incidence of TAVF and FTA was 2.3% (6/256) in the first study and 6.8% (14/206) in the second. According to experience of Davidović et al, is not that low. The incidence of TAVF and FTA, which included 140 cases, was 17.85%, and in civilian study with 273 cases it was 21.24% [11].

The most frequent cause of penetrating wounds during wars, as under civilian conditions, are bullets (figure 1) and fragments from various exploding devices (figure 2). In civilian experience, FTA and TAVF result from stab wounds as well [12]. FTA can also be caused by secondary damage, followed by pathologic moving of a bone fracture after penetrating and blunt trauma. In Davidović et al study, most of the FTA (superficial femoral 23.4% and popliteal 19.15%) were found at vessels near long bones (figure 3 and 4) [13]. Blunt trauma without associated bone fracture can also result in FTA and [14-16] (figure 5).

Figure 1.

FTA after gun-shut injury

Figure 2.

FTA and multifragments in right limb

Figure 3.

False traumatic aneurysm of the left-side brachial artery developed after a stab injury, which was accidental, job-related, and self- inflicted. a Angiography. b Intraoperatively, a laceration is apparent on the front wall of the brachial artery

Figure 4.

False traumatic aneurysm of the right-side axillary artery developed as the result of a gunshot injury

Lesions of the intrathoracic segment of the supraaortic branches can be often fatal. Formation of an FTA is not uncommon [17,18]. In 1968, Vollmar and Krumhaar described two such cases among 200 FTA, while Beall et al [19], Rich et al. [5], and Davidović et al [13] found only one such case (figure 6). In the most important war studies published between 1946 and 1975, all carotid arteries (common, external, internal) were involved in 3.8–20.5% of cases [6-8,20]. The incidence of all carotid arteries (common, external, internal) being involved, according to two of the most important civilian studies published during the same period, was 14.3–18% [10,12,13,21] (figure 6, 7 and 8).

In all of these studies FTA were mainly associated with lower extremity vessel (46.0–69.46%).6-13, 20

Figure 5.

FTAof temporal artery after blunt injury

Figure 6.

False traumatic aneurysm (arrowhead) of the left common carotid artery (arrow) developed after blunt trauma

Figure 7.

a Angiography reveals a false traumatic innominate artery aneurysm (arrow) that developed after chest blunt trauma during a car accident. b Note the right common carotid artery (white arrow) and the closed proximal end of the innominate artery (black arrow)

Figure 8.

a Dacron bypass graft from the ascending aorta to the right common carotid and right subclavian artery. An 8-mm ringed polytetrafluoroethylene (PTFE) graft has been used to repair the injured left brachiocephalic vein. b MSCT performed 1 month later showed that both Dacron and PTFE grafts are patent

Advertisement

5. Diagnostic

The diagnosis of FTA is not difficult when the ‘‘hard signs’’ are present [22-24]. The problem is finding a way to recognize these signs and avoid failing to recognize FTA when the clinical picture is not typical [25]. Angiography has still very important roll as method of diagnostic, appropriate surgical approach as well as the type of vascular repair. Sophisticated diagnostic procedures, such as computed tomography, are extremely useful in cases of complex FTA.

Advertisement

6. Natural history and treatment

Natural history of FTA could be distal embolization (figure 9), rupture (figure 10), neurogenic compression or venous (figure 11) and cardiac failure. These lesions require prompt treatment. The treatment is relatively simple if the interval between injury and operation is not long [8,14,25-31]. Primary arterial repair without grafting is usually not feasible in late-presenting cases owing to the chronic nature of the FTA and the presence of fibrosis and inflammation. In the case of a small aneurysm, resection and primary end-to-end repair can be the safest alternative, although some advocate graft interposition [32]. The material of choice for repair is autologous saphenous vein [8,26,28-32]. The use of synthetic grafts is not recommended during the early phase because of infection. Synthetic grafts should be used only for a chronic FTA that involves large arteries (e.g., common femoral, subclavian).

Figure 9.

Embolization FAA and severe right foot ischemia after femoropopliteal reconstruction

Figure 10.

Rare case of ruptured FTA after blunt injury in right gluteal reg.

Figure 11.

FTA of left axillar artery; neurogenic and venous compression

According to some, endovascular procedures can be important in the management of critically injured patients, as well as those with chronic FTA [33-43]. Endovascular repair of a peripheral FTA seems attractive because it theoretically results in less morbidity and shorter hospitalization [33]. However, this experience is still limited, especially in young patients. There is also skepticism regarding the use of stents in the popliteal artery. The reason is the mobility of the knee joint. Because of their history of numerous complications, FTAs require prompt treatment. The treatment is simpler if there is not an extended interval between the injury and the operation. Endovascular repair is mostly indicated in locations where a surgical approach is not easily attained.

Advertisement

7. False anastomotic aneurysms (FAA)

Most common false aneurysm belongs to group of anastomotic aneurysms and they present clinical challenges in detection, evaluation, and treatment. The incidence is approximately between 1.4% and 4% [44]. Claytor and associates, in 1956, reported the first case of anastomotic aneurysm in a patient after prosthetic aortic graft placement [45].

In 1978, Wesolowski outlined these common causes of FAA [46]:

  1. Suture material

  2. Prosthesis defects in manufacture

  3. Arterial changes

  4. Other factors

Although silk was used as a suture material for anastomosis (prior to 1967), the most frequent cause of FAA was breaking of the suture material [47-54]. Introduction of synthetic polyfilament suture materials has significantly decreased this cause. Also, the prosthesis defects in manufacture have long ceased to be the cause of the FAA. A whole range of arterial wall changes could lead to the formation of an FAA: infection arterial degeneration, aseptic necrosis of the suture line, extensive endarterectomy, and large ‘‘patch’’ or anastomosis, according to the Laplace rule [53-63]. A mechanical stress in the anastomotic area was the most important cause from the group of ‘‘other’’ factors. Movements in the hip area creating this kind of stress are recognized as the reason for the most frequent occurrence of FAA in the inguinal area after aortobifemoral reconstruction [49,55,62,64,65]. Growth of tissue created between the graft and the inguinal ligament prevents the graft from ‘‘sliding’’ over the ligament when a hip movement is performed [49]. For this reason, the FAA often develops after aortofemoral reconstruction but rarely develops after axillofemoral, femorofemoral, or femoropopliteal reconstruction. Szilagyi and colleagues believed this is the reason for the FAAs that manifest later [53]. In his discussion of the Stoney and Albo study [47], Baker suggested that anastomosis in the femoral region must be covered by a mobilized sartorius muscle to decrease stress. Mechanical stress caused by insufficient graft length [50] or configuration of end-to-side anastomosis [47,56,66] and the mechanical stress caused by an extensive mismatch, occurring if the prosthesis is too rigid, are also described. With every pulse wave, the anastomotic part of the artery is dilated at least 10% more than the prosthesis. Given that this difference increases with the size of mismatch, the least resistant structures (suture material, artery, prosthesis) could be broken [57,67-70]. These pathogenic mechanisms are more likely to happen on an end-to-side than on an end-to-end anastomosis [66-71]. At first sight, it is normal to expect that FAAs develop more often after the reconstructive procedures performed owing to aneurysmal and not occlusive diseases. In other words, it could be expected that aneurysmal degeneration can enhance FAA development. However, there are not many studies on that.

There are some systemic factors which are thought to contribute to anastamotic aneurysm formation: smoking, hypertension, hyperlipidemia, anticoagulation, systemic vasculitides and generalized arterial weakness [72,73].

Advertisement

8. Incidence

According to the literature, FAAs most often develop in the inguinal area [74-78]. They can develop after the aortofemoral or infrainguinal bypass (figure 13, 14 and 15). They develop in 14 to 44% of inguinal anastomoses [57,63,68,79], although the cumulative risk in clinically significant FAAs is probably less than 10% [80-84]. Inguinal FAA development is clearly a matter of time for the risk increases with the age of the patient and the graft. The literature cites the following frequency of FAA after the aortofemoral bypass operation: 0.4% [85], 1.4% [86], 2% [87], 3.2% [88], 3.3% [89], 3.9% after 17 years of monitoring [53], 4% [90], 4.7% [91], 7% [92], 3.88% [93], and 4.3 [94]%. Cintora and colleagues stated that the FAA incidence in the aortobifemoral position is 4% if a Dacron graft is used and just 1% if a PTFE graft is used, all types taken into account [95]. If the publishing dates are analyzed, the number of FAAs was larger at an early age owing to the poorer quality of the prosthesis and suture material. Data in table 1. show changes in interval of inguinal FAA development through time [96].

PeriodTime Interval (mo)
Before 197536–48 [53,100]
1976–198037–73 [52,70,78,88]
1981–199072–92 [49,83,99]
After 1990111 [99]

Table 1.

Time Intervals of the Appearance of False Anastomotic Aneurysm

The main reason for this is the improvement in surgical technique and better quality of prosthetic and suture material. Also, it takes longer for the other etiopathogenetic factors, with the exception of the infections, to develop. Some literature data cite the fact that partial section of the inguinal ligament and enlargement of the tunnel in which the prosthesis lies, combined with free omental wrapping of the entire suture line, decrease the incidence of FAA [80].

Aortic FAAs are rare [77,97-99], and with the total number of operations in mind, their incidence of occurrence ranges from 2 to 10% [68-71]. They are believed to be more frequent after emergency procedures. Also, they are much more frequent after end-to-side than after end-to-end anastomosis [77] (figure 16) Owing to the development of surgical procedures, the occurrence of aortic FAAs has decreased to less than 1% [99]. With the lack of symptoms, it is difficult to diagnose aortic FAA. They are often detected during the evaluation of other abdominal diseases and conditions. Sometimes patients can notice the existence of a pulsatile abdominal mass, back pain, or weight loss [97,98]. Unfortunately, many aortic FAAs present only with acute expansion, rupture, gastrointestinal bleeding, infection, or distal embolism [94,95,97]. They are, in that manner, similar to abdominal aortic aneurysms.

The incidence of anastomotic aneurysm after carotid endarterectomy (with or without patch angioplasty) is approximately 0.3% [100]. They are most commonly associated with prosthetic infection [101].

Advertisement

9. Natural history and treatment

The disease development course of FAA, as well as that of any other aneurysm in general, can be complicated by a rupture (figure 12), compression, thrombosis, neurogenic compression and distal embolism [53,59,77,78,102,104,105]. Demarche and colleagues describe their experience with 142 femoral anastomotic aneurysms [106]. 64% were presented as an asymptomatic pulsatile mass, 19% presented with acute limb ischemia, 9% presented as a painful groin mass, 7% presented with acute hemorrhage, two patients (1%) presented with distal microemboli and limb edema. Infection was presented in 7% of all anastomotic aneurysms. Other series report similar presentations [107-109].

Figure 12.

Ruptured FAA in left groin

Sometimes it is very difficult to prove that infection is the cause of an FAA. Keeping in mind that an intraoperative culture and blood culture can often have a false-negative result, the surgeon has to rely on intraoperative findings. Perigraft infiltration or fluid and the absence of graft incorporation in the surrounding tissue could be the only signs of graft infection. Laboratory parameters such as CRP level and white blood cell count can help us make a decision. In cases characterized by the absence of infection, there is a choice in FAA treatment between the methods of complete or partial resection and graft interposition or bypass procedure [58,92,94,96,105]. In case of an infection as the cause of the FAA, only two treatment options are considered: ‘‘in situ’’ repair with a homoarterial graft and EAR [67,110]. Incidence of infection as a cause of FAA can be an underestimation considering the existence of low-virulence pathogens and false-negative intraoperative culture examinations. On the other hand, Edwards and colleagues found in their 45-month follow-up study that only 5.5% had FAA as a symptom of late graft infection [63]. Reinfection after 30 postoperative days appeared in one patient (4.8%).

Other than standard surgical approach, there have been cases in the literature recently in which FAA was treated by an endovascular placed graft [111]. Using this method in cases of FAA in the groin, problems can be caused by kinking and thrombosis of the implanted stent graft. It is hoped that very soon technology development will resolve this problem and provide a fast, safe, and less invasive procedure with better results. Several authors have published recent series on successful endovascular treatment of anastomotic aneurysms (table 2).

Number of PatientsResults (%)Mean Follow-up (mo)
SeriesYearLocationTechniqueAdjunctive ProcedureInfectedTechnical SuccessMajor Compli-cations30-Day MortalityPatency
Yuan et al.[112]199712A/ICovered stentNoNo100170100%16
Curti et al.[113]200111ICovered stentNoYes10000100%28
Magnan et al.[114]200310ACovered stentYesNo10010090%17.7
Faries et al.[115]200333A/ICovered stentYesNo100110
Gawenda et al.[116]200310A/ICovered stentYesNo100010100%
van Herwaarden et al.[117]20048A/ICovered stentNoNo10020088%12
Derom and Nout[118]20057FCovered stentNoNo10000100%18.6
Mitchell et al.[119]200710A/ICovered stentYesNo100100
Di Tommaso et al.[120]20076ACovered stentYesNo10000100%26.1
Lagana et al.[121]200730A/ICovered stentYesNo1000391%19.7
Piffaretti et al.[122]200722A/ICovered stentYesNo1005096%16
Sachdev [123]200765A/ICovered stentYesYes9893.8094%18.1

Table 2.

, aortic; F, femoral; I, iliac.Taken from Rutherford’s Vascular Surgery, 7th ed. -- Endovascular Management of Anastomotic Aneurysms)

Figure 13.

Angiography; False anastomotic aneurysms in both groins

Figure 14.

FAA in left groin after femoropopliteal reconstruction

Figure 15.

FAA in distal anastomosis after femoropopliteal reconstruction

Figure 16.

FAA after aortobifemoral reconstruction with end to side proximal anastomosis

References

  1. 1. Schwartz AM1958The historical development of methods of hemostasis.Surgery604 EOF10 EOF
  2. 2. MatasR.1888Traumatic aneurysm of left brachial artery. Med News 53:462
  3. 3. MatasR.1909Aneurysms. In: Keen WW, Da Costa JC (eds) Surgery: its principles and practice,5Saunders, Philadelphia,266268
  4. 4. SoubbotichV.1913Military experiences of traumatic aneurysms. Lancet2720721
  5. 5. Rich NM, Clagett GP, Salander JM et al1983The Matas/ Soubbotitch connection. Surgery931719
  6. 6. Elkin DC, Schumacker HB Jr1955Arterial aneurysms and arteriovenous fistula: general considerations. In: Elkin DC, De Bakey ME (eds) Surgery in World War II. Vascular surgery. Office of the Surgeon General, Department of the Army, Washington, DC,149180
  7. 7. Hughes CW, Jahnke EJ Jr1958The surgery of traumatic arteriovenous fistulas and aneurysms: a five year follow up study of 215 lesions.Ann Surg148790797
  8. 8. Rich NM, Hobson RW, Collins GJ Jr1975Traumatic arterio- venous fistulas and false aneurysms: a review of 558 lesions. Surgery78817828
  9. 9. PattmanR. D.PoulosE.ShiresG. T.1964The management of civilian arterial injuries. Surg Gynecol Obstet118725738
  10. 10. HewittR. L.SmithA. D.DrapanasT.1973Acute traumatic arteriovenous fistulas.J Trauma13901906
  11. 11. DavidovicL. B.CinaraI. S.IlleT.et al.2005Civil and war peripheral arterial trauma: review of risk factors associated with limb loss.Vascular13141147
  12. 12. Roobs JV, Carrim AA, Kadwa AM et al1994Traumatic arte- riovenous fistula: experience with 202 patients. Br J Surg 81:1296
  13. 13. DavidovicL. B.BanzićI.RichN.DragašM.CvetkovicS. D.DimicA.False traumatic aneurysms and arteriovenous fistulas: retrospective analysis. World J Surg.2011Jun;356137886
  14. 14. MegalopoulosA.SiminasS.TrelopoulosG.2007Traumatic pseudo aneurysm of the popliteal artery after blunt trauma: case report and a review of the literature. Vasc Endovasc Surg1499504
  15. 15. Gillespie DL, Cantelmo NL1991Traumatic popliteal artery pseudo aneurysms: case report and review of the literature. J Trauma31412415
  16. 16. Rosenbloom MS, Fellows BA1989Chronic pseudo aneurysm of the popliteal artery after blunt trauma. J Vasc Surg10187189
  17. 17. MatasR.1902Traumatic arteriovenous aneurysms of the subclavian vessels, with an analytical study of fifteen reported cases, including one operated upon. JAMA 38:103 20.
  18. 18. GallenJ.WissD. A.CantelmoN.et al.1984Traumatic pseudo-aneurysm of the axillary artery: report of three cases and literature review. J Trauma24350354
  19. 19. Beall AC Jr, Harrington OB, Crawford ES et al1963Surgical management of traumatic arteriovenous aneurysms.Am J Surg106610618
  20. 20. VollmarJ.KrumhaarD.1968Surgical experience with 200 traumatic arteriovenous fistulae. In: Hiertonn T, Rybeck B (eds) Traumatic arterial lesions. Forsvarets Forskningsanstalt, Stockholm
  21. 21. YetkinU.GurbuzA.2003Investigation of post-traumatic pseudo aneurysm of the brachial artery and its surgical treatment. Tex Heart Inst J30293297
  22. 22. Woodlark JD, Reddy DS, Robs JV2003Delayed presentation of traumatic popliteal artery pseudo aneurysms: a review of seven cases. Eur J Vasc Endovasc Surg2325525930
  23. 23. Pritchard DA, Malonez JD, Barnhorst DA et al1977Traumatic popliteal arteriovenous fistula: diagnostic methods and surgical management.Arch Surg11284985231
  24. 24. La ̈dermann A, Stern R, Bettschart V et al (2008) Delayed post- traumatic pseudoaneurysm of the anterior tibial artery mimicking a malignant tumor. Orthopedics 31:500
  25. 25. DavidovicL.LotinaS.VojnovicB.et al.1997Post-traumatic AV fistulas and pseudoaneurysms.J Cardiovasc Surg38645651
  26. 26. LinderF.1 EOF5 EOF1985Acquired arterio-venous fistulas: report of 223 operated cases.Ann Chir Gynaecol 74:1 27.
  27. 27. MMHegartyAngorn. I. B.GolloglyJ.et al.1975Traumatic arterio-venous fistulae. Injury 7:20
  28. 28. TreimanL.CohenL.GaspardJ.et al.(1971) Early repair of acute arteriovenous fistulas. Arch Surg102559561
  29. 29. KollmeyerR.HuntL.EllmanA.et al.(1981) Acute and chronic traumatic arteriovenous fistulae in civilians. Arch Surg116697702
  30. 30. FolleyJ.AllenV.JanesM.1956Surgical treatment of acquired arteriovenous fistulas. Am J Surg 91:611
  31. 31. Losev RZ, IuA Burov, Alimov VK et al1994The treatment of posttraumatic and true arterial aneurysms of the extremities. Vestn Khir Im I Grek1534347
  32. 32. DarbariA.TandonS.ChandraG.et al.2006Post-traumatic peripheral arterial pseudo aneurysms: our experience. Indian J Thorac Cardiovasc Surg22182187
  33. 33. Marin ML, Veith FJ, Panetta TF et al1994Transluminally placed endovascular stented graft repair for arterial trauma.J Vasc Surg20466472
  34. 34. DorrosG.JosephG.1995Closure of a popliteal arteriovenous fistula using an autologous vein-covered Palmaz stent.J Endo- vasc Surg2177181
  35. 35. UflackerR.BMElliot1996Percutaneous endoluminal stent- graft repair of an old traumatic femoral arteriovenous fistula. Cardiovasc Interv Radiol 19:120 EOF122 EOF
  36. 36. CriadoE.MarstonW. A.LigushJ.et al.1997Endovascular repair of peripheral aneurysms, pseudoaneurysms, and arteriovenous f ́ıstulas.AnnVascSurg11256263
  37. 37. Manns RA, Duffield RG1997Case report: intravascular stenting across a false aneurysm of the popliteal artery.Clin Radiol52151153
  38. 38. Reber PU, Patel AG, Do DD et al1999Surgical implications of failed endovascular therapy for posttraumatic femoral arteriovenous fistula repair. J Trauma 46:352
  39. 39. ColdwellD. M.NovakZ.RyuR. K.et al.2000Treatment of posttraumatic internal carotid arterial pseudoaneurysms with endovascular stents.J Trauma48470472
  40. 40. RedekopG.MarottaT.WeillA.2001Treatment of traumatic aneurysms and arteriovenous fistulas of the skull base by using endovascular stents.J Neurosurg95412419
  41. 41. AssaliA. R.SdringolaS.MoustaphaA.et al.2001Endovascular repair of traumatic pseudoaneurysm by uncovered self-expand- able stenting with or without transstent coiling of the aneurysm cavity. Catheter Cardiovasc Interv53253258
  42. 42. Ramsay DW, McAuliffe W (2003) Traumatic pseudoaneurysm and high flow arteriovenous fistula involving internal jugular vein and common carotid artery: treatment with covered stent and embolization. Australas Radiol 47:177-180
  43. 43. SelfM. L.MangramA.JeffersonH.et al.2004Percutaneous stent-graft repair of a traumatic common carotid-internal jugular fistula and pseudoaneurysm in a patient with cervical spine fracturesJ Trauma5713311334
  44. 44. GoldstoneJ.Anastamoticaneurysms.InBernard. V. M.TowneJ. B.edComplications in Vascular Surgery, St Luis, MO: Quality Medical Publishing;1991
  45. 45. BirchL.CardwellE. S.ClaytorH.et al.Suture-linerupture.ofa.nylonaortic.bifurcationgraft.intosmall.bowelA. M.AMBirchL.CardwellE. S.ClaytorH.et al.Suture-linerupture.ofa.nylonaortic.bifurcationgraft.intosmall.bowelA. M. AMA Arch Surg 1954;73:947Arch Surg1954947 EOF50 EOF
  46. 46. ASWesolovskiA.pleafor.earlyrecognition.oflate.vascularprosthetic.failureSurgery1978845756
  47. 47. Stoney RJ, Albo EJ.False aneurysms occurring after arterial grafting operations.Am J Surg196511015361
  48. 48. Moore WS, Hall AD.Late suture failure in the pathogenesis of anastomotic false aneurysms.Ann Surg197017210648
  49. 49. Read RC, Thompson BW.Uninfected anastomotic false aneurysms following arterial reconstruction with prosthetic grafts.J Cardiovasc Surg19751655861
  50. 50. KimG. E.ImparatoA. M.NathanI.RilesT. S.Dilatation of synthetic grafts and junctional aneurysms. Arch Surg19791141296303
  51. 51. Sawyers JL, Jacobs JK, Sutton JP. Peripheral anastomotic aneurysms. Arch Surg 1967;95:802-9.
  52. 52. GaylisH.Pathogenesis of anastomotic aneurysms.Surgery19819050915
  53. 53. Szilagyi DE, Smith RF, Elliot JP, et al. Anastomotic aneurysms after vascular reconstruction: problems of incidence, etiology and treatment. Surgery 1975;78:800-16.
  54. 54. MarkovicD. M.DavidovićL. B.KostićD. M.MaksimovićZ. L.KuzmanovićI. B.KoncarI. B.CvetkovicD. M.Falseanastomotic.aneurysmsVascular.2007May-Jun;1531418
  55. 55. WatanabeT.KusabaA.KumaH.et al.Failure of Dacron arterial prostheses caused by structual defect. J Cardiovasc Surg19832495100
  56. 56. ClarkE. T.GewertzB. L.PseudoaneurysmsIn.RutherfordR. B.editorVascular.surgery4th.edPhiladelphia. W. B.Saunders199511531161
  57. 57. GutmanH.ZelinovskiA.ReissR.Rupturedanastomotic.pseudo-aneurysmsafter.prostheticvascular.graftbypass.proceduresJ Med Sci1984206137
  58. 58. BroynT.ChristensenO.FossdalE.et al.Early complications with a new bovine arterial graft (Solcograft-P).Acta Chir Scand19861522636
  59. 59. Seabrook GR, Schmitt DD, Bandyk DF, et al. Anastomotic femoral pseudoaneurysm: an investigation of occult infection as an etiologic factor.J Vasc Surg19901162934
  60. 60. Merrill EW, Salzam EW.Properties of material affecting the behavior of blood and their surfaces. In: Sawyer PN, Kaplitt MJ, editors. Vascular graft. New York: Appleton Century Crofts;1978119129
  61. 61. NunnD. B.FreemanM. H.HudginsL.Postoperative alterations in size of Dacron aortic grafts: an ultrasonic evaluation.Ann Surg19791897415
  62. 62. DubostC.AllaryM.OlconomosN.Resection of an aneurysm of the abdominal aorta. Reestablishment of the continuity by a preserved human arterial graft with result after five months. Arch Surg1952644058
  63. 63. Edwards MJ, Richardson JD, Klamer TW.Management of aortic prosthetic infections. Am J Surg198815532730
  64. 64. Orringer MD, Rutherford RB, Skiner DB.An unusual complication of axillary femoral arterial bypass. Surgery19727276971
  65. 65. DardikH.IbrahimI. M.JarahM.et al.Synchronous aortofemoral or iliofemoral bypass with revascularization of the lower extremity.Surg Gynecol Obstet197914967680
  66. 66. DadgarL.DownsA. R.DengX.et al.Longitudinal forces acting at side-to-end and end-to-side anastomoses when a knitted polyester arterial prosthesis is implanted in the dog.J Invest Surg1995816378
  67. 67. Paasche RE, Kinly CE, Dolan FG, et al.Consideration of suture line stresses in the selection of synthetic grafts for implantation.J Biomech197362539
  68. 68. SieswerdaC.SkotnickiS. H.BarentzJ. O.HeystratenF. M. J.Anastomotic aneurysms-an underdiagnosed complication after aorto-iliac reconstructions.Eur J Vasc Surg198932338
  69. 69. McCann RL, Schwartz LB, Georgiade GS.Management of aortic graft complications. Ann Surg199321772934
  70. 70. BastounisE.GeorgopoulosS.MaltezosC.BalasP.The validity of current vascular imaging methods in the evaluation of aortic anastomotic aneurysms developing after abdominal aortic aneurysm repair.Ann Vasc Surg19961053745
  71. 71. BergerK.SauvageL. R.Late fiber deterioration in Dacron arterial grafts.Ann Surg198119347791
  72. 72. AlpagutU.UgurlucanM.DaytogluE.Majorarterial.involvementreviewof.Behýet’sdisease.Ann Vasc Surg2007
  73. 73. Oderich GS, PannetonJM, Bower TC, et al:The spectrum, management and clinical outcome of Ehlers-Danlos syndrome type IV: a30-year experience.J Vasc Surg2005
  74. 74. WandschneiderD.BullP. H.DenckA.Anastomotic-ananeurysms.unsolubleproblem.EurJ.VascSurg198821159
  75. 75. Knox GW.Aneurysm occuring in a femoral arterial Dacron prosthesis five and a half years after insertion. Ann Surg196215682730
  76. 76. GiordanengoF.PizzocariP.RampoldiV.et al.Femoral non-infected anastomotic pseudoaneurysm. Clinical contribution. Minerva Chir199215478239
  77. 77. Guinet C, Buy JN, Ghossain MA, et al. Aortic anastomotic pseudoaneurysms: US, CT, MR, and angiography. J Comput Assist Tomogr 1992;16:128-8.
  78. 78. WaibelP.False aneurysm after reconstruction for peripheral arterial occlusive disease. Observations over 15 to 25 years.Vasa1994234351
  79. 79. Shwartz LB, Clark ET, Gewertz BL.Anastomotic and other pseudoaneurysms. In: Rutherford RB, editor. Vascular surgery. 5th ed. Philadelphia: W.B. Saunders;2000752763
  80. 80. CourbierR.FerdaniM.JausseranJ. M.et al.The role of omentropexy in the prevention of femoral anastomotic aneurysm. J Cardiovasc Surg19923314953
  81. 81. MelliereD.BecqueminJ. P.Cervantes-MonteilF.et al.Recurrent femoral anastomotic false aneurysms: is long term repair possible? Cardiovasc Surg199644802
  82. 82. MilliliJ. J.LanesJ. S.NemirP. A.studyof.anastomoticaneurysms.followingaortofemoral.prostheticbypass.Ann Surg19801926973
  83. 83. Ernst CB, Elliott JP Jr, Ryan CJ, et al.Recurrent femoral anastomotic aneurysms: a 30-year experience.Ann Surg19882014019
  84. 84. Ernst CB. Anastomotic aneurysm. In: Ernst CB, Stanley JC, editors.Current therapy in vascular surgerySt. Louis: Mosby-Year Book;1995415419
  85. 85. PouliasG. E.PolemisL.SkoutasB.et al.Bilateral aorto-femoral bypass in the presence of aorto-iliac occlusive disease and factors determining result. J Cardiovasc Surg1985;2625737.
  86. 86. Brewster DC, Darling DC.Optimal methods of aortoiliac reconstruction.Surgery19788473947
  87. 87. MaloneJ. M.MooreW. S.GoldstoneJ.Life expectancy following aortofemoral arterial grafting.Surgery1977815515
  88. 88. NevelsteenA.WoutersL.SuyR.Long-term patency of the aortofemoral Dacron graft. A graft limb related study on a 25 year period. JCardiovasc Surg19913217480
  89. 89. Gomes MR, Bernatz PE, Jurgens JL.Influence of clinical factors on results. Arch Surg19679538794
  90. 90. Martinez BD, Hertzer NR, Beven EG.Influence of distal arterial occlusive disease on prognosis following aortobifemoral bypass.Surgery19737451923
  91. 91. Crawford ES, Bomberger RA, Glaeser DH, et al. Aortoiliac occlusive disease: factors influencing survival and function following reconstructive operation over a twenty-five year period.Surgery198190105567
  92. 92. Crawford ES, Manning LG, Kelly TF.Redo’’ surgery after operations for aneurysm and occlusion of the abdominal aorta.Surgery1977814152
  93. 93. Davidovic ́ L. Comparison between bifurcated Dacron and PTFE grafts in aortobifemoral position [dissertation]. Belgrade: University of Belgrade School of Medicine; 1995.
  94. 94. LeviN.SchroederT. V.Anastomoticfemoral.aneurysmsis.anincrease.ininterval.betweenprimary.operationaneurysmsformation.relatedto. a.changein.incidence?Panminerva.Med1998402103
  95. 95. CintoraI.PaeroD. E.CanonJ. A. A.clinicalsurvey.ofaortobifemoral.bypassusing.twoinherently.differentgraft.typesAnn Surg198820862530
  96. 96. LeviN.SchroederT. V.Anastomoticfemoral.aneurysmsincrease.ininterval.betweenprimary.operationaneurysmformation.Eur J Vasc Endovasc Surg1996112079
  97. 97. GautierC.BorieH.LagneauP.Aortic false aneurysms after prosthetic reconstruction of the infrarenal aorta.Ann Vasc Surg199264137
  98. 98. ChenF. Z.XuX.FuW. G.WuZ. G.Anastomotic false aneurysm following abdominal aortic aneurysmectomy and prosthetic grafting.Chin Med J (Engl)19941078325
  99. 99. De Monti M, Ghilardi G, Sgroi G, Scorzo R. Proximal anastomotic pseudoaneurysms. Minerva Cardioangiol 1995;43:127-34.
  100. 100. Branch Jr CL, Davis Jr CH: False aneurysm complicating carotid endarterectomy.Neurosurgery1986421 EOF5 EOF
  101. 101. Borazjani BH, Wilson SE, Fujitani RM, et al: Postoperative complications of carotid patching: pseudoaneurysm and infection.Ann Vasc Surg2003156 EOF61 EOF
  102. 102. DeBakey ME, Crawford ES, Morris GC, Cooley LA.Patch graft angioplasty in vascular surgery. J Cardiovasc Surg1963310641
  103. 103. Satiani B, Karmers M, Evans NE. Anastomotic arterial aneurysms. Ann Surg 1980;192:674-82.
  104. 104. TridicoF.ZanS.PanierSuffat. P.et al.Femoralanastomotic.pseudoaneurysmsThe etiopathogenetic hypotheses and the therapy. Minerva Chir1992473740
  105. 105. MorbidelliA.CaronR.CaldanaG.et al.Bilateral thrombosis of a femoral pseudoaneurysm. Minerva Chir19955010138
  106. 106. DemarcheM.WaltregnyD.van DammeH.et al.Femoralanastomotic.aneurysmspathogenic.factorsclinical.presentationstreatmentA study of 142 cases.Cardiovasc Surg1999315 EOF22 EOF
  107. 107. SchellackJ.SalamA.MAAbouzeidet.alFemoral.anastomoticaneurysms. a.continuingchallenge. J.VascSurg.1987
  108. 108. Youkey JR, Clagett GP, Rich NM, et al: Femoral anastomotic false aneurysms: an11-year experience analyzed with a case control study.Ann Surg1984
  109. 109. ArgifoglioG.CostantiniA.LorenziG.et al.Femoralnoninfected.anastomoticaneurysms.J Cardiovasc Surg1990
  110. 110. MulderE. J.van BockelJ. H.MaasJ.et al.Morbidity and mortality of reconstructive surgery of noninfected false aneurysms detected long after aortic prosthetic reconstruction.Arch Surg1998133459
  111. 111. DorrosG.JaffM. R.ParikhA.et al.In vivo crushing of an aortic stent enables endovascular repair of a large infrarenal aortic pseudoaneurysm.J Endovasc Surg1998535964
  112. 112. YuanJG, Marin ML, Veith FJ, et al:Endovascular grafts for noninfected aortoiliac anastomotic aneurysms.J Vasc Surg1997210 EOF21 EOF
  113. 113. CurtiT.StellaA.RossiC.et al.Endovascularrepair.asfirst-choicetreatment.foranastomotic.trueiliac.aneurysmsJ Endovasc Ther2001139 EOF143 EOF
  114. 114. Magnan PE, Albertini JN, Bartoli JM, et al: Endovascular treatment of anastomotic false aneurysms of the abdominal aorta.Ann Vasc Surg2003365 EOF74 EOF
  115. 115. FariesP. L.WonJ.MorrisseyN. J.et al.Endovasculartreatment.offailed.priorabdominal.aorticaneurysm.repairAnn Vasc Surg200343 EOF8 EOF
  116. 116. GawendaM.ZaehringerM.BrunkwallJ.Openversus.endovascularrepair.ofpara-anastomotic.aneurysmsin.patientswho.weremorphological.candidatesfor.endovasculartreatment.J:Open versus endovascular repair of para-anastomotic aneurysms in patients who were morphological candidates for endovascular treatment.J Endovasc Ther2003745 EOF51 EOF
  117. 117. Van Herwaarden JA, Waasdorp EJ, Bendermacher BLW, et al: Endovascular repair of paraanastomotic aneurysms after previous open aortic prosthetic reconstruction.Ann Vasc Surg2004280 EOF6 EOF
  118. 118. DeromA.NoutE.Treatmentof.femoralpseudoaneurysms.withendograft.inhigh-risk.patientsEur J Vasc Endovasc Surg2005644 EOF7 EOF
  119. 119. Mitchell JH, Dougherty KG, Strickman NE, et al.Endovascular repair of paraanastomotic aneurysms after aortic reconstructionTex Heart Inst J.200734148153
  120. 120. Di TommasoL.MonacoM.PiscioneF.et al.Endovascular stent grafts as a safe secondary option for para-anastomotic abdominal aortic aneurysm.Eur J Vasc Endovasc Surg.2007339193
  121. 121. LaganaD.CarrafielloG.ManginiM.et al.Endovasculartreatment.ofanastomotic.pseudoaneurysmsafter.aorto-iliacsurgical.reconstructionCardiovasc Intervent Radiol20071185 EOF1191 EOF
  122. 122. PiffarettiG.TozziM.LomazziC.et al.Endovasculartreatment.forpara-anastomotic.abdominalaortic.iliacaneurysms.followingaortic.surgeryJ Cardiovasc Surg2007711 EOF7 EOF
  123. 123. SachdevU.BarilD. T.MorrisseyN. J.et al.Endovascular repair of para-anastomotic aortic aneurysmsJ Vasc Surg.2007636 EOF641 EOF

Written By

Igor Banzić, Lazar Davidović, Oliver Radmili, Igor Končar, Nikola Ilić and Miroslav Marković

Submitted: December 11th, 2011 Reviewed: May 11th, 2012 Published: August 29th, 2012