Giant paraanastomotic iliac artery pseudoaneurysm/Dev paraanastomotik iliyak arter yalanci anevrizmasi.

False aneurysms of iliac artery after prosthetic vascular reconstruction are considered to be rare complications with uncertain incidence.

An 82-year-old male patient with the complaints of flank pain and intermittent claudication was admitted to our clinic. He had had a bilateral aortoiliac bypass procedure 25 years before. On physical examination he had a transverse infraumbilical surgical incision scar and a pulsatile mass on his right lower quadrant of the abdomen with dermal bruits. On the contrast enhanced computed tomographic (CT) angiography, a right sided giant iliac artery paraanastomotic pseudoaneurysm of 13x12 cm was detected (Fig. 1).

Under spinal and epidural anesthesia with right flank incision and retroperitoneal approach, after proximal control of the graft with nylon tape (Fig. 2) and intravenous anticoagulation the graft was clamped and the aneurismal sac was opened. The iliac artery was ligated and the graft was extended with an end-to-end anastomosed 8-mm Dacron tube graft. The distal anastomosis was done to the common femoral artery (Fig. 3). A total of 1000 ml of red blood cell was retransfused with the aid of cell saver. He had an uneventful recovery and discharged on the fifth postoperative day.

Anastomotic aneurysms, early after the operation has an incidence of 3%. The reported incidences of pseudoaneurysms assessed by life-table analysis are 20% and 22.8% at 15 years. Paraanastomotic aneurysms can be complicated by rupture, thrombosis, embolism, and pressure on or erosion into adjacent structures. Surgery of ruptured paraanastomotic aneurysms has mortality rates ranging from 24 to 70% and morbidity rates ranging from 70 to 83%. Mortality rate for elective open repair of paraanastomotic aneurysms is 3 to 17%. Infection is the most common etiologic factor. Suture deterioration and pathologic prosthetic dilation, hypertension, poor outflow vessels, progression of distal disease, local endarterectomy, healing complications, type of suture material, type of graft material, postoperative anticoagulation, the type and location of anastomosis, and tension on the suture line are other factors. The delay of occurrence of iliac false aneurysms ranges between 6 to 10 years. Therefore it has been proposed to perform a systematic follow-up with CT examination every 5 years. Blood loss may be high enough to endanger the life of the patient in such a big pseudoaneurysm if the open surgery is preferred. Even as in our case the aneurysmal sac blood content loss may be life threatening. Therefore, red blood saving measures prior to intervention are of critical importance.

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Bilgin Emrecan, Ibrahim Goksin

Department of Cardiovascular Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey

E-mail: [e-mail]

Address for Correspondence/Yazisma Adresi: Bilgin Emrecan Pamukkale Universitesi, Kalp ve Damar Cerrahisi Anabilim Dali, Denizli, Turkey E-mail: [e-mail]