False aneurysms of the proximal anastomosis of the arterial prosthesis and the abdominal aorta

Abstract

Due to a false aneurysms of the aortic-prosthetic anastomosis ten patients aged 42-74 years underwent surgery. In three patients, an aneurysm occurred twice. One was operated on after the aneurysm had ruptured. Six patients were treated for hypertension. In the course of the primary procedure, in six cases aortic-bifemoral grafts were implanted, in four--an aortic-femoral, and in two aortic-biiliac grafts were used. In six patients end-to-end anastomoses were performed, and in four--end-to-side. Surgical corrections due to the occurrence of a false aneurysm were performed 3 months to 10 years after the original surgery. On reoperation, purulent matter was found in the site of the prosthesis. In two patients, aortic-intestinal fistulas were detected, and in one--an aortic-cecal fistula. In six patients the anastomoses were totally separated. In the course of 13 procedures performed in false aneurysms, five times replaced, single sutures were applied to the entire circumference of the anastomosis in four cases, including one case where an oblong patch was also used, in three cases an extra segment was sutured between the aorta and the previously implanted prosthesis, and the aneurysmal sac was filled with wire in one patient. Eight patients were reoperated, including three repeated procedures due to a false aneurysm of the proximal anastomosis. Moreover, the patency of prostheses was restored, abscesses were surgically opened and procedures were performed in the colon. Four patients have survived, including one with bilateral amputation of lower limbs. The most common cause of death was myocardial infarction. Two patients died due to massive hemorrhage, and one as a result of uremia.