Anastomotic pseudoaneurysms. A continuing late complication of vascular reconstructive procedures

Anastomotic pseudoaneurysms continue to be a late complication of vascular grafting procedures. We reviewed the records of 48 patients who presented with 65 abdominal or lower extremity anastomotic pseudoaneurysms during 1977 to 1985. The interval between the original operation and the development of a pseudoaneurysm was 6.2 years (range, 2.5 months to 19 years). Most patients underwent resection of the involved segment of graft and artery with placement of an interposition graft. Graft patency was 97.5% during a mean follow-up of 2.4 years (range, two months to five years), and one operative mortality occurred. Four patients had emergency procedures; one patient underwent reconstruction, and three others underwent resection of the pseudoaneurysms alone. Two of those patients died, and the one survivor eventually required a high amputation. We recommend aggressive diagnosis and surgical reconstruction in these patients usually by interposition grafts or anastomotic revisions because the short- and long-term results are excellent. Morbidity and mortality are greatly increased when these procedures are done emergently.