Repair of an Anastomotic Pseudoaneurysm with a Novel Hybrid Technique

Introduction: Anastomotic false aneurysms are a late complication of aortic grafting. Treatment usually consists of débridement of the degenerated tissue and placement of a short interposition graft. In infectious situations, graft excision is required.

Patient history: An 80-year-old frail man with numerous comorbidities presented to clinic with an anastomotic pseudoaneurysm (PSA) between the left limb of an aortobifemoral Dacron graft and the common femoral artery (FA).

Technical details: The superficial FA (SFA) and deep FA (PFA) were exposed and controlled from an anterior thigh approach. Sheaths were inserted in each artery. An Amplatzer II vascular plug (Abbott, Abbott Park, IL) was deployed in the PFA. A Viabahn (Gore, Flagstaff, AZ) was first deployed in the left limb of the Dacron graft and into the proximal SFA. A Viabahn VBX stent (Gore, Flagstaff, AZ) was then deployed from inside the Viabahn and going proximally further into the limb of the bifurcated Dacron graft. The proximal end of the Viabahn VBX was flared with a larger balloon. The arteriotomies in the SFA and PFA were then used to create a side-to-side anastomosis. There were no immediate complications. On 6 months follow-up, the PSA sac was noted to have decreased in size, and the stents to be patent with no endoleak.

Discussion: Elective surgical repair of anastomotic PSAs is preferred since emergent repair has significantly higher morbidity and mortality. Still, open elective repair has its own mortality and limb loss risks in addition to postoperative wound infection, seroma, hematoma, and recurrence, along with myocardial infarction and stroke. The novel procedure we performed eliminated the risk factors of redo groin incision and added easier-to-control vessels in a clean field. With this procedure being performed more often in the future, these changes will hopefully prove to reduce complications while preserving flow in both the SFA and PFA.