[Anastomotic pseudoaneurysms of the femoral bifurcation. Clinical experience]

The authors report their experience of the treatment of anastomotic pseudoaneurysms of the femoral tripod. The paper analyses 231 cases treated over the past 8 years by the Division of Vascular Surgery using an alloplastic prosthetic implant in correspondence with the femoral tripod. Pseudoaneurysms were observed in 23 patients (9.8%) and emergency corrective surgery was required in 10 cases (43%) and elective surgery in 13 (56.5%). A total of 6 trans-obturator by-passes, 2 femoro-femoral by-passes using the saphena vein, 2 axillo-popliteal by-passes, 8 resections and re-implants, and 5 ligatures were performed. Immediate permeability was obtained in 15 patients, whereas 5 were amputated at the thigh and the remaining patient undergoing ligature preserved the limb but with chronic ischemic symptoms; 2 patients died. In the long-term follow-up of those patients who were permeable on discharge, permeability had persisted in 5 (83%) treated with trans-obturator by-pass and in 7 (87%) who had undergone resection and re-implant. The remaining axillo-popliteal by-pass had thrombosed after 6 months but the patient had not lost the limb. The authors underline the unpredictability of this pathology and analyse the causes which may provoke the development of this complication which inevitably leads to thrombosis or hemorrhage. However, suture materials (continuing pseudoaneurysm in spite of not using silk), the infective etiology (the extreme difficulty of obtaining a positive bacteriological culture) and the inguinal region (onset of pseudoaneurysm during aorto-femoral by-pass but hardly ever during femoro-popliteal by-pass) may be contributory causes but not decisive factors.(ABSTRACT TRUNCATED AT 250 WORDS)