[False aneurysms in prostheses of the aortic bifurcation. Apropos of 34 case reports]

Thrombosis, infection, false aneurysm and hemorrhage are all complications occurring following reconstructive arterial surgery. The authors study what is certainly the most unusual of these complications, i. e. development of false aneurysms of prostheses of the aortic bifurcation. They describe the various etiological factors responsible for their onset and also new diagnostic features and the principles of re-operation as well as results. This study is based upon a series of 34 cases of false aneurysm of prostheses of the aortic bifurcation inserted over a ten year period from 1974 to 1984. During this period, 1,400 prostheses of aortic bifurcation were inserted, essentially for two indications: chronic obliterative arterial disease of the lower limbs and aneurysmal disease. The mean latent period of onset of the complication was four and a half years. Removal followed by insertion of a new prosthetic graft is the basic treatment, overall mortality being 4% and morbidity being 30%, dominated by secondary thrombosis in 19% of cases, local infection in 8% of cases and recurrence of aneurysm in the same percentage of individuals. The overall figure of very good results was 70%. Whilst discussion is dominated by the role of different etiological factors, it nevertheless remains important to note that only progress in prosthetic and suture materials can allow a future decrease in the percentage of such false aneurysms, the factor inherent in the vascular surgeon, i. e. operative technique itself, being much easier to deal with on principle. This complication nevertheless remains very serious, best dealt with by surgery since the natural history of this false aneurysm is completely different from that of a classical femoral or popliteal aneurysm.