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Hybrid Technique for Excluding Large Femoral Anastomotic Pseudoaneurysms After Aortobifemoral Bypass
Ashley Tameron, MD, Sophia Afridi, MD, Nessa Miller, MD, Patrick Muck, MD, Matthew Recht, MD.
Good Samaritan Hospital, Cincinnati, OH, USA.
OBJECTIVE - Arterial pseudoaneurysms are known complications after endovascular procedures and open vascular surgeries. The femoral region is the most common site for anastomotic pseudoaneurysms. Significant morbidity and mortality are associated with conventional open pseudoaneurysm repairs. Since Dr. Parodi’s report in 1991, endovascular techniques have proven successful in aneurysm repair to decrease postoperative morbidity and long term mortality. Our goal is to detail a novel use of hybrid endovascular exclusion technique in femoral anastomotic pseudoaneurysms.
METHODS -The superficial femoral artery and profunda femoral artery were exposed through an undissected plane distal to the previous operative site under general anesthesia. A 9 French sheath was placed into superficial femoral artery in retrograde fashion. Retrograde arteriograms were performed identifying the native external iliac and profunda femoral arteries. The external iliac artery was embolized, as it was patent in both patients. Sequential, overlapping (9 mm, 8 mm, 7 mm) ViaBahn® stent grafts were inserted from the aortobifemoral limb into the SFA. Once completion arteriogram showed exclusion of the pseudoaneurysm, the profunda femoral was translocated onto the SFA distal to ViaBahn® graft via an open incision.
RESULTS -This technique was successfully used in two patients who had a remote history of aortobifemoral bypasses and distal anastomotic pseudoaneurysms. The first case was a 78 year old man with multiple medical comorbidities including a newly diagnosed lung cancer and a left lower quadrant end colostomy. His symptomatic 10 cm left femoral anastomotic pseudoaneurysm was repaired successfully using this hybrid technique. The second case was a 79 year old woman with significant cardiopulmonary comorbidities. Her 14 cm right femoral anastomotic pseudoaneurysm was successfully treated with this hybrid technique. At latest follow up, both patients had patent repairs.
CONCLUSIONS -The gold standard of femoral anastomotic pseudoaneurysm treatment, open surgical repair, may not be possible in patients with multiple medical comorbidities or specific anatomic factors. The described hybrid technique allows safe and effective repair of large femoral anastomotic pseudoaneurysms.
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