Intermittent aortic-graft obstruction secondary to anastomotic aneurysms

Diagnosis of anastomotic aneurysms is usually suggested by simple palpation of a pulsatile mass on physical examination. Diagnosis may be more difficult, and clinical appearance more unusual, for those aneurysms occurring in an intra-abdominal location. This article reports an unusual manifestation of bilateral iliac-artery false aneurysms, ie, intermittent obstruction of aortic-graft blood flow. Femoral pulses were absent and significant peripheral ischemia present with the patient's legs extended. Femoral pulses returned to normal with the patient's legs flexed. Perianastomotic fibrosis, the mass effect of the false aneurysms, and possible kinking of the partially disrupted suture line with tensing of the psoas muscle on extension of the legs are possible causes of the intermittent obstruction to blood flow. The varied clinical manifestations and general principles of operative repair of anastomotic aneurysms are described.