Anastomotic aneurysms--an underdiagnosed complication after aorto-iliac reconstructions

Anastomotic aneurysms (AA) are recognised as a long-term complication of aorto-iliac (AI) reconstructions and in the literature an incidence of 2-8% is reported. From our own experience we suspected a much higher frequency of this complication and started a follow-up study in order to establish: 1. The actual incidence of AA and 2. The value of various methods of investigation in the diagnosis of this condition. During a 4-year-period (1977-1980) 303 patients (PTS) underwent an AI reconstruction and were the subject of this study. During the mean 8-year (range 6-10 years) follow-up period 158 patients died (52%). The 145 survivors underwent physical examination (PE), ultrasonography (US), and intravenous digital subtraction angiography (i.v. DSA). Complete data were available from 122 patients. The incidence of AA in the 303 patients of the original group, established by routine follow-up examination was 16/303 (5.1%). However, the incidence of AA in the 122 patients in this study was 36/122 (29.5%). These 36 patients developed 52 AA which were located at the following anatomic sites: aortic anastomoses 3/115 (2.6%), iliac artery anastomoses 18/146 (12.3%), femoral artery anastomoses 31/70 (44.3%). Fourteen of the 52 AA (33%) were operated on and the diagnosis was confirmed. The patient characteristics (age distribution, type of arterial reconstruction, indication for operation) of the group of 122 patients were not significantly different from the original group of 303 patients. Intravenous DSA proved to be the most reliable diagnostic test. Physical examination was relatively inaccurate when compared with imaging tests with a 37% false positive and 67% false negative rate.(ABSTRACT TRUNCATED AT 250 WORDS)