Changing Etiology of Anastomotic Aneurysms

Abstract

Anastomotic aneurysms in patients at the Seattle Veterans Administration Medical Center between 1974-1979 were analyzed to determine their etiol ogy. Thirty-nine aneurysms occurred in 29 patients with 19 aneurysms presenting in 15 patients who had vascular reconstruction at our institution. The site most commonly involved was the femoral anastomosis (5%/anas tomosis) followed by the iliac (2%) and the aortic (0.5%) anastomoses. Mechanical forces appear to be the most common cause (76%) followed by graft infection (23%) with suture failure being very uncommon (2%) Histo logic examination of the aneurysms thought to be produced by mechanical forces disclosed normal host artery wall in 1 group and aneurysmal degen erative change in the remainder. The generation of disruptive forces at anastomoses between compliant and stiff materials and their role in produc ing anastomotic disease is discussed. A disturbing feature is the incidence of commensal infections seen previously in other prosthetic surgery.