Summary
Over a period of 20 years (1970 to 1989) 145 patients underwent aortoiliac reconstruction by means of TEA. Closure of the arterial incision was performed by patch plasty in 141 patients (97.3%). All 145 patients were included in this study. 36 patients (24.8%) died during the follow-up period ranging from 1 to 20 years (mean: 10.7 years).
Complete data were available from 60 patients (41.4%). The incidence of false aneurysm was 43.3%.
The results of physical examination were relatively inaccurate when compared with those obtained by ultrasound, CT and MRI. Most of the false aneurysms occurred between 5 and 13 years after surgery. 73.1% of them had a diameter of 2.5 to 5.0 cm, while 26.9% were greater than 5.0 cm. 31.4% of the patients were asymptomatic, 15.5% presented with rupture and 7.7% died of this complication. All ruptured aneurysms had a diameter of more than 5.0 cm.
The results of our study suggest that patch plasty should not be used for closure of the aortoiliac incision in TEA in order to prevent the development of false aneurysm. Asymptomatic patients presenting with false aneurysms of less than 5.0 cm in diameter should be examined regularly, while patients with larger aneurysms should undergo bypass surgery as soon as possible.
Zusammenfassung
Falsche Aneurysmen nach aortoiliakaler Desobliteration und Patchplastik traten bei 43,3% unseres Krankengutes auf und werden vor allem zwischen dem 5. und 13. postoperativen Jahr beobachtet. Als zielführende diagnostische Methode haben sich Ultraschall und MRI bestens bewährt, CT und Angiographie wurden zusätzlich präoperativ vorgenommen.
Die Ursache für die Entstehung der Patchaneurysmen wird in einer Überkorrektur bei der Erstoperation gesehen und als logische Konsequenz der lineare Verschluß der Inzision ohne Patch empfohlen. Falsche Aneurysmen sollten trotz der zu erwartenden technischen Schwierigkeiten operiert werden, sobald sie diagnostiziert wurden, da sie im eigenen Krankengut für 15,3% der Rupturen und eine 7,7%ige Mortalität verantwortlich zeichnen. Als Rekonstruktionsmethode kommt ausschließlich die Bifurkationsprothese mit Anschluß in beiden Leisten in Betracht.
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© 1992 Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt
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Weimann, S. et al. (1992). Pseudoaneurysma nach aortoiliakaler Desobliteration und Patchplastik. In: Hepp, W. (eds) Aortoiliakale Verschlußprozesse. Berliner Gefäßchirurgische Reihe, vol 4. Steinkopff. https://doi.org/10.1007/978-3-642-72484-8_24
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DOI: https://doi.org/10.1007/978-3-642-72484-8_24
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