Anastomotic False Aneurysms Following Femoropopliteal Vein Bypass: A Case Report

Abstract

Anastomotic false aneurysms following femoro-popliteal bypass with autogenous saphenous vein seem to be a very rare complication according to the literature. Three patients with a total of five false aneurysms are presented. The primary operations were performed within 3 weeks. We can give no definite explanation of the occurrence. Infection in association with silk sutures or inferior quality of the silk are possible aetiological factors. With manifest false aneurysm, re-operation is always indicated. The arteries will have to be ligated above and below the aneurysm, and every effort must be made to restore distal arterial circulation. A second vein should be inserted, bypassing the possible infected area of the false aneurysm. In the groin, this can easily be accomplished with the vein placed in the femoral canal.

The incidence of anastomotic false aneurysms following femoropopliteal bypass procedures is reported to be higher than 10% with Teflon and Dacron graft in one series (Sawyers et al., 1967), and as high as 23.7% in another (Stoney et al., 1965). In femoropopliteal bypass with autogenous vein, however, they seem to constitute a very rare complication. LePere (1969) and Steenaert et al. (1970) state that no aneurysms have yet been seen following vein grafting in their experience. We have been able to find only one case mentioned earlier in the literature (Spratt et al., 1967). There are probably other reports that we missed, and there are certainly unreported cases. Thus, in the course of a few months, we have seen 3 patients develop a total of five false aneurysms following femoropopliteal bypass with autogenous saphenous vein. The patients were operated upon for occlusive disease with progressive claudication of the calf. The primary operations were performed in succession within 3 weeks by two different resident surgeons under supervision. Conventional technique was used: The saphenous vein was reversed with end-to-side anastomosis using continuous 5/0 or 6/0 silk sutures. Heparin was not used. In the prophylaxis of thrombosis, 500 ml of Macrodex were given every other day for 1 week postoperatively. The immediate postoperative course was uneventful in all 3 patients with no signs of infection. Peripheral pulses were restored and claudication was relieved. Further details are briefly presented in the case histories.