Tratamiento combinado abierto y endovascular de aneurismas anastomÓticos postinjerto bifurcado aortobifemoral

Summary Introduction Anastomotic aneurysms are subject to the same complications as a true aneurysm and their choice and emergency treatment present very high morbidity and mortality rates. We describe a case in which a combined open and endovascular technique was used to treat the aneurysmatic complication of an aortobifemoral graft. Case report Lesions were identified in a 70-year-old male, 11 years after an aortobifemoral by-pass was performed to treat an aortoiliac ischemic disease. A right femoral pseudoaneurysm was identified by palpation and echo-Doppler. In the pre-operative study, a computerised tomography (CT) scan of the abdom-inopelvic cavity was performed and revealed an aortic anastomotic pseudoaneurysm. The femoral lesion was treated using conventional surgery, a short 8 mm PTFE by-pass from the right-hand branch of the bifurcate to the deep femoral artery. Due to the high surgical risk (ASA IV) and a hostile abdomen, the exclusion of the aortic pseudoaneurysm was performed by implanting a straight stent under intradural anaesthetic. After freeing the stent, a distal leakage of contrast medium was noted and corrected by placing a covered straight stent extension. Immediate arteriographical control did not show any flow of contrast inside the aneurysmatic sac. There were no post-operative complications and the patient remained asymptomatic. The control CT at six months confirmed the complete exclusion of the pseudoaneurysm. Conclusion In a case in which open surgery represents a high risk, endovascular treatment of uninfected aortic anastomotic pseudoaneurysms is feasible. [ANGIOLOGIA 2002; 54: 402-8].