Suture Material as a Factor in the Occurrence of Anastomotic False Aneurysms

Starr, David S.; Weatherford, Stephen C.; Lawrie, Gerald M.; Morris, George C.

doi:10.1001/archsurg.1979.01370280066009

Cited by 53 publications

(16 citation statements)

References 3 publications

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“…The main cause of bleeding in this situation is the rupture of arterial pseudoaneurysms in the operating field. Different pathophysiological mechanisms have been suggested for this entity which mainly causes delayed massive haemorrhage [13,24,25,26,27,28,29,30,31]. …”

Section: Discussionmentioning

confidence: 99%

Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed

Koukoutsis¹,

Bellagamba²,

Morris‐Stiff³

et al. 2006

Dig Surg

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Aim: To document the prevalence and to evaluate the management strategies of haemorrhagic complications following pancreaticoduodenectomy (PD). Methods: All patients who underwent PD from 1/2000 to 10/2005 and experienced at least one episode of haemorrhage during the 30 first days postoperatively were recorded. Etiology of haemorrhage, treatment strategy and mortality rate were recorded and analyzed. Results: A total of 362 patients underwent PD during this period and 32 (8.8%) had haemorrhage postoperatively of whom 15 died (47% mortality rate). Primary intraluminal haemorrhage was recorded in 13 patients, primary intra-abdominal haemorrhage in 5 patients and secondary haemorrhage in 14 patients. Successful management of haemorrhage with angioembilization occurred in 2 patients in the study group. Statistical analysis revealed sepsis and sentinel bleed as risk factors for post-PD haemorrhage and pancreatic leak and sentinel bleed as risk factors for secondary haemorrhage (p < 0.05). Conclusions: Haemorrhage after PD is a life-threatening complication. Sepsis, pancreatic leak, and sentinel bleed are statistical significant factors predicting post-PD haemorrhage. Sentinel bleed is not statistically significant associated with postoperative mortality, but with the onset of secondary haemorrhage. The effectiveness of therapeutic angioembolization was not demonstrated in our study.

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Section: Discussionmentioning

confidence: 99%

Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed

Koukoutsis¹,

Bellagamba²,

Morris‐Stiff³

et al. 2006

Dig Surg

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“…1,5 The suture material used for the anastomosis is a well-known factor in the development of false aneurysms. 19 The use of silk sutures, which are known to have problems with degeneration, contributed significantly to the prevalence of false aneurysms early in this series. However, as seen in our series, false aneurysms may also occur after using stable suture material.…”

Section: Commentmentioning

confidence: 98%

Morbidity and Mortality of Reconstructive Surgery of Noninfected False Aneurysms Detected Long After Aortic Prosthetic Reconstruction

Mulder¹

1998

Arch Surg

128

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To determine the morbidity and mortality of surgical treatment of false (anastomotic) aneurysms, we analyzed the results of 158 consecutive surgical procedures for repair of false aneurysms that were detected as a result of a surveillance program after aortic reconstruction with a prosthesis. Design: Retrospective analysis of patient data from a vascular registry that included information on the longterm follow-up of our patients. Setting: A university hospital (tertiary referral center) in the Netherlands that has been performing vascular reconstructive surgery since 1958. Patients: We performed 158 surgical procedures on 135 patients with 220 noninfected false aneurysms. Using a yearly surveillance program, the false aneurysms were detected at a mean interval of 8 years after the initial reconstruction. Most patients (60%) were asymptomatic. The operation was performed as an emergency in 25 instances (16%). Results: The mortality rate of patients receiving nonsurgical treatment was very high (61%) owing to documented rupture (11 of 18 patients). The intraoperative death rate was 7.6% per procedure. This was higher for emergency (24%) than for elective procedures (4.5%).

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“…Discontinuity of the anastomosis causes a false PAAA that usually occurs as a result of arterial wall disruption and mechanical stress4,7,9,13-20 rather than because of graft/suture material failure 21. Aorta versus graft compliance/diameter mismatch9,10,13,14 and extreme mechanical stress (greater in end-to-side rather than end-to-end anastomoses) at the suture-line play major pathogenetic roles 4,10,19-24.…”

Section: Discussionmentioning

confidence: 99%

Uninfected Para-Anastomotic Aneurysms after Infrarenal Aortic Grafting

et al. 2009

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Purpose This single-institution retrospective review examines the management of uninfected para-anastomotic aneurysms of the abdominal aorta (PAAA), developed after infrarenal grafting. Materials and Methods From October 1979 to November 2005, 31 PAAA were observed in our Department. Twenty-six uninfected PAAA of degenerative etiology, including 24 false and 2 true aneurysms, were candidates for intervention and retrospectively included in our database for management and outcome evaluation. Six (23%) patients were treated as emergencies. Surgery included tube graft interposition (n = 12), new reconstruction (n = 8), and graft removal with extra-anatomic bypass (n = 3). Endovascular management (n = 3) consisted of free-flow tube endografts. Results The mortality rate among the elective and emergency cases was 5% and 66.6%, respectively ( p = 0.005). The morbidity rate in elective cases was 57.8%, whereas 75% in emergency cases ( p = 0.99). The survival rate during the follow-up was significantly higher for elective cases than for emergency cases. Conclusion Uninfected PAAA is a late complication of aortic grafting, tends to evolve silently and is difficult to diagnose. The prevalence is underestimated and increases with time since surgery. The mortality rate is higher among patients treated as an emergency than among patients who undergo elective surgery, therefore, elective treatment and aggressive management in the case of pseudoaneurysm are the keys to obtain a good outcome. Endovascular treatment could reduce mortality. Patients who undergo infrarenal aortic grafting require life-long surveillance after surgery.

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Suture Material as a Factor in the Occurrence of Anastomotic False Aneurysms

Cited by 53 publications

References 3 publications

Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed

Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed

Morbidity and Mortality of Reconstructive Surgery of Noninfected False Aneurysms Detected Long After Aortic Prosthetic Reconstruction

Uninfected Para-Anastomotic Aneurysms after Infrarenal Aortic Grafting

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