Chapter 48 - Anastomotic aneurysms Flashcards
Rate of anastomotic aneurysms
1-4% of all anastomoses
Most common site of anastomotic aneurysm
femoral artery 0.5-24% of all
Rate of carotid anast aneurysms after CEA and carotid aneurysm repair
- 3%
aneurysm: 13-57% bad tissue
Factors associated with anastomotic aneurysm
LOCAL
1) arterial wall degeneration
2) suture line disruption
3) prosthetic graft failure
4) infection/inflammation
5) technical errors
6) mechanical stress
SYSTEMIC
1) smoking
2) hyperlipidemia
3) HTN
4) anticoagulation
5) systemic vasculitides
6) generalized arterial weakness
Prolene is what
monofilament polypropylene
benefit of prolene
1969
1) minimal tissue reactivity
2) low thrombogenicity
3) resistance to infection
4) low coefficient of friction
5) maintenance of tensile strength
6) no biodegradation
Causes of inflammation at anastomoses that can cause pseudoaneurysm
1) hematoma
2) lymphocele
3) acquired vasculitides Behcet’s disease
Rate of recurrent aneurysm in chronic inflammatory conditions
30-50%
Symptoms of femoral anastomotic aneurysms
asymptomatic pulsatile mass 64%
ALI 19%
painful mass 9%
hemorrhage 7%
Rate of infection of anastomotic aneurysms
7%
Rate of a synchronous anastomotic aneurysm when a femoral is found
36%
Rate of a femoral aneurysm when an abdominal anastomotic one is found
13%
Indication to repair
1) femoral > 2 cm
2) symptomatic
3) intracavitary
4) saccular
5) carotid
6) infection
Suprainguinal incision
1) incision between ASIS and between pubis and umbilicus
2) divid abdominal wall muscles
3) identify preperitoneal plane
4) exposure carried posteriorly with blunt dissection
Mortality rate after aortic anastomotic aneurysm repair
3-17%
