Obstructive uropathy secondary to a false aneurysm in 12 years after abdominal aneurysmectomy

Long-tern follow-up of patients having abdominal aneurysmectomy and graft replacement will show that a considerable number develop false aneurysms at the anastomotic sites. This is the particularly true in situations in which silk suture was used for the vascular anastomoses. Successful management of this problem necessitates an awareness that unsuspected, asymptomatic ureteral obstruction can be a complicating factor. Preoperative work-up of all abdominal aortic problems should include an intravenous pyelogram. When evidence of ureteral obstruction is encountered, retrograde ureteral catheterization is important to precisely identify the point of obstruction and to aid in the ureterolysis at the time of operation. Inadvertent injury and contamination from an obstructed ureter is a situation which must be avoided when prosthetic grafting is anticipated.