Uninfected anastomotic false aneurysms following arterial reconstruction with prosthetic grafts

Thirteen men, aged 49 to 76 years, average 60, were treated at the Little Rock, Arkansas Veterans Administration Hospital between January 1, 1969 and January 1, 1974 for 1-3 false aneurysms, a total of 18, following prosthetic arterial grafting. Most (ten patients, 15 aneurysms) had aorto-femoral bifurcation grafts for Leriche syndrome. Dacron prostheses were employed in ten, Teflon in three. The interval between the initial operation and the appearance of the aneurysms averaged six years. The end-to-side femoral anastomosis broke down in all ten patients with Leriche syndrome. Six of the eight unilateral aneurysms were on the right side, two had bilateral aneurysms and one patient had three. Five patients died some months or years after repair from vascular accidents. Three other patients required amputations sometime later because their grafts clotted. Silk sutures were employed in only two patients. Plastic sutures in the others were found to have pulled out of the recipient vessels. The aneurysms were all uninfected and were repaired by local stitching in four and the addition of further plastic grafting in nine. We conclude that false aneurysms occur with plastic sutures and they relate primarily to disruption of the end-to-side femoral artery attachment from the stresses of movement at the hip joint.