Stent graft repair of anastomotic pseudoaneurysm of femoral–popliteal bypass graft following patch angioplasty

Abstract

Pseudoaneurysm (PA) following vascular reconstruction is a complication of bypass surgery. Historically, the mainstay of treatment was an open repair; the surgical management consisted of resection of the initial graft with reimplantation of a new bypass either into the original arteriotomy or to a more distal target. Placement of a stent graft to exclude the PA is a viable option. We present a case of an 85-year-old man with prior history of polytetrafluoroethylene femoral–popliteal bypass now with an 8 × 5.6 cm PA of the distal anastomosis site treated with endovascular placement of a Viabahn stent.

Endovascular Treatment of Venous Bypass Graft Pseudoaneurysm with the New Solaris Self-Expanding Covered Stent

“…Many infrainguinal bypass grafts are in a subcutaneous position, making surgical repair the most expeditious and desirable procedure. Other minimally invasive treatment options include ultrasound-guided compression, percutaneous thrombin injection, and endovascular treatment [3,4]. In high-risk patients, an endovascular approach is a practical therapeutic method and offers an attractive option because it avoids the need for reoperation in a previously scarred area.…”

Femoropopliteal Bypass Surgery: Great Saphenous Vein Graft Rupture

“…Pseudoaneurysm (PA) can develop as a delayed presentation in surgically revascularized patients. Given the rising number of reconstructive vascular procedures, the increase in anastomotic PA cases is expected [2]. The clinical presentation of PA may vary from patient to patient.…”

“…Other presentations include acute and chronic limb ischemia, bleeding secondary to rupture and an asymptomatic pulsatile mass [2]. Although the majority of PA is secondary to trauma or iatrogenic injury, other etiologic factors are post-operative infections, suture fatigue, poor suture material, post-operative nicotine use, recurrent operations to the same site and mechanical obstruction [2]. If left untreated, PA may lead to thrombosis, rupture or distal embolization [2].…”

“…Great saphenous vein (GSV) grafts are commonly used as bypass conduit for lower limb revascularisation due to its advantages over the synthetic graft in terms of durability and complication free outcomes [1]. GSV bypass graft aneurysm rupture is a rare entity with an incidence < 1% but can prove to be fatal if goes unrecognised [2]. This can be prevented by technical modifications.…”

An iliac arterial pseudoaneurysm diagnosed 40 years after suffering blunt trauma

“…Based on this evidence, it is assumed that the pseudoaneurysm of the iliac artery increased chronically. Although stent grafts have been reported to be effective for the treatment of pseudoaneurysms [ 5 , 6 ], we decided to perform open surgery because the aneurysm extended to the common femoral artery, which meant that there was not enough landing zone for stent graft.…”