Predictors of development of anastomotic femoral pseudoaneurysms after aortobifemoral reconstruction for abdominal aortic aneurysm

Abstract Background The pathogenesis of anastomotic femoral pseudoaneurysms (AFPs) is still unclear. We have performed this long-term retrospective study of patients who underwent aortobifemoral reconstruction for abdominal aortic aneurysm (AAA) in order to better establish the long-term rate of AFP and to identify the predictors of its late occurrence. Methods The long-term outcome of 178 patients who underwent and survived aortobifemoral reconstruction for infrarenal AAA was reviewed. Results During a median follow-up of 5.2 years, 28 AFPs developed in 19 patients. Six AFPs were recurrent. The mean linearized rate of AFPs was 1.88% per year. At 15 years, the survival-freedom rate from AFPs was 60%, and from repair of AFPs it was 62%. The survival-freedom rate from AFP was significantly poorer in patients with chronic obstructive pulmonary disease ( P = 0.017; at 10 years: 64.3% versus 92.3%), hyperlipidemia ( P = 0.0056; at 10 years: 59.2% versus 87.5%), current smoking ( P P P P = 0.001, 9.2% versus 1.5% per year). Conclusions Current smoking and inguinal wound infection may contribute to the development of AFP after aortobifemoral reconstruction for AAA, likely by affecting reparative connective tissue mechanisms at the anastomotic site.