Endovascular prosthetic reconstruction in treatment of a false aneurysm of a proximal anastomosis of the iliac-femoral bypass

Presented herein is the outcome of endovascular repair of a proximal anastomotic aneurysm in a male patient after previously performed iliac-femoral bypassing. Implanted was endograft Hemobahn (GORE-TEX Company), with good immediate and remote outcomes obtained. Anastomotic aneurysms are known to be one of the long-term complications following reconstructive operations performed on the aorto-iliac-femoral segment [1,2,3]. Currently, the most commonly used operation in management of all types of anastomotic aneurysms is reconstruction of the anastomosis involved using a segment of a new by-pass between the old graft and the donor artery [1,4]. In case of a proximal-anastomosis aneurysm, reconstruction of the anastomosis is accompanied and followed by replacement of the whole aorto-femoral or iliac-femoral bypass [5], as well as the operations on aortic ligation combined with axillofemoral shunting [6]. Along with it, there have appeared sporadic publications reporting successful application of endografts in treatment of anastomotic aneurysms after reconstructive operations. In their work, van Herwaadren J. A. et al. had presented positive outcomes of endovascular treatment of anastomotic aneurysms, true aortic aneurysms and iliac artery aneurysms, which had been revealed after iliac-femoral reconstructions [7]. They had treated a total of 14 patients presenting with false aortic and iliac arteries aneurysms, having developed 4 to 18.4 years after surgery (averagely after 8.8 postoperative years). The patients received linear or bifurcated endografts. After 12 months, haemorrhage into the aneurysmal cavity was observed in three patients only. According to the authors' opinion, the endografts turned out rather an efficient therapeutic method within the medium-term follow up. We present herein out first experience in endovascular prosthetic reconstruction of a proximal-anastomosis aneurysm after previously performed iliac-femoral bypassing. This is, in our opinion, an interesting case report, for one and the same patient underwent two different therapeutic techniques carried out during two separate hospital admissions. He was primarily subjected to a reconstruction operation for a distal-anastomosis aneurysm, with endografting of the proximal anastomosis aneurysm being performed during his second hospital stay.