Transverse rupture of ring-supported Dacron graft 10 years after axillobifemoral artery bypass: induced by graft deterioration and Fogarty thrombectomy

Case Report: False aneurysm as a late unusual complication of the aortofemoral bypass graft in a patient with critical leg ischemic symptoms: interesting case

Aortofemoral bypass surgery is a common procedure for treating aortoiliac occlusive disease, also known as Leriche syndrome, which can cause lower extremity ischemic symptoms. Diagnostic imaging techniques play a crucial role in managing pseudoaneurysms (PSAs), with Duplex ultrasound and Computed Tomography-angiography (CTA) being effective tools for early diagnosis. Pseudoaneurysms (PSAs) present as pulsating masses with various symptoms, and prompt intervention is essential to avoid complications. A case report is presented involving an 82-year-old male who underwent aorto-bifemoral bypass surgery and later developed a pseudoaneurysm (PSA) of the left branch. Surgical treatment involved the removal of the pseudoaneurysm (PSA) and graft replacement. Other cases from the literature are also described, emphasizing the rarity and potential severity of non-anastomotic pseudoaneurysms (PSAs) in reconstructive vascular surgery. Periodic screening of patients who undergo reconstructive vascular surgery is crucial to detect pseudoaneurysms (PSAs) early and prevent complications. Asymptomatic pseudoaneurysms (PSAs) can grow significantly and become life-threatening if not identified in a timely manner. Regular post-operative imaging, such as annual Computed Tomography-angiography (CTA) and/or Duplex ultrasound, is recommended to ensure early diagnosis and appropriate management of complications.

[Graft aneurysms as long-term complication of polyester prostheses and their management : Brief review based on a systematic review of the literature]

INTRODUCTION

A material-associated true aneurysm after previous use of a vascular prosthesis for arterial reconstruction mostly in peripheral arterial occlusion disease (PAOD) is considered a rare but serious complication.

AIM AND METHOD

The aim of the compact brief review was to describe the rare finding of a true aneurysm of a prosthesis and its diagnosis-specific care including a representative scientific case report, based on selected topic-related references from the medical literature as well as the specific experiences obtained from the successful clinical management in single cases. RESULTS (COMPLEX KEY POINTS ASSOCIATED WITH PATIENT AND CLINICAL FINDINGS AND CASE PRESENTATION): Out of initially 321 references found in the literature search, 20 articles published after 1995 were finally evaluated. Most frequently, pseudoaneurysms of knitted polyester prostheses at the femoropopliteal segment occurred on average after approximately 12.9 years. In one third of the cases two or more aneurysms of Dacron prostheses were described. Histological and electron microscopy investigations revealed mainly breakage of filaments and foreign body reactions. In more than half of the patients, the aneurysm was resected and for reconstruction an interposition graft was implanted. Complete removal of the prosthesis and endovascular treatment were only second choice.

REPRESENTATIVE CASE

A 49-year-old male patient underwent a femoropopliteal P1 prosthetic bypass of the right leg in 1997. After 19 years a true aneurysm of the prosthesis was diagnosed in the right thigh using duplex ultrasonography and complementary magnetic resonance angiography (MRA). This was successfully treated with resection of the aneurysm and insertion of an 8‑mm Dacron prosthesis (Intergard Synergy Knitted, InterVascular, Bensheim, Germany).

CONCLUSION

The development of true aneurysms of prostheses has not yet been satisfactorily clarified. This belongs to the profile of late complications, even if rarely and should be controlled after a postoperative interval of approximately one decade. This should be carried out by diagnostic imaging follow-up screening if the previous arterial recanalization/reconstruction could not be performed sequentially following endovascular intervention and venous-based reconstruction, other than with prosthetic material.