Results of Open Repair of Giant Femoral Anastomotic Aneurysms

Document Type

Conference Proceeding

Publication Date

6-1-2025

Publication Title

J Vasc Surg

Abstract

Objectives: Open repair of giant femoral artery anastomotic aneurysms (FAAAs) can be a challenging operation, particularly in those with rupture and with recurrent anastomotic aneurysms. We report on the results of open repair of giant FAAAs and explore the use of technical maneuvers to assist in achieving successful outcomes. Methods: Among patients with open FAAA repairs, 16 (Group A) were identified with giant aneurysms (greater than 6.5 cm). During the same time interval, 69 patients underwent open repair of 3.5- to 6.4-cm FAAAs (Group B). The study was conducted from vascular registries of two teaching hospitals (2000-2024). Both groups were compared using Fisher Exact and Student t-test. Results: Both groups were similar in age and risk factors. Among 16 patients who underwent FAAA repairs for giant aneurysms (9 men), five presented with rupture, and 11 presented with local compressive symptoms. The diameter of FAAA was 6.5 to 8 cm in 10 patients and 8.1 to 9.5 cm in six patients. In patients with giant FAAAs, four had prior ipsilateral aortofemoral and contralateral aortoiliac graft for repair of abdominal aortic aneurysm; 11 had aortobifemoral graft for occlusive disease, and one had femoropopliteal graft for exclusion of popliteal aneurysm. Repair necessitated retroperitoneal exposure of the graft limb/external iliac artery (EIA) in five patients. Intraluminal control of deep femoral artery with number 5 or 6 arterial dilators was used in 14 repairs. Interposition prosthetic graft (8 mm) was used for repair from proximal common femoral artery to femoral artery bifurcation (n = 7), to deep femoral artery (n = 3), to the origin of lower extremity bypass (n = 2), and reimplantation of the deep femoral artery using a Carrell patch into the interposition graft (n = 4). One patient died following repair of a ruptured FAAA (6.2%) due to respiratory failure, and one had a late major amputation (above knee) approximately 1 year later due to occlusion of the femoral popliteal bypass. At a mean follow-up of 8.4 ± 2.6 years (range, 1-22 years), seven patients died; none were related to FAAA repair. No patient had a recurrence of FAAAs. Conclusions: Giant FAAAs appear later than conventional FAAAs following index operation. Repair of giant FAAAs as compared with conventional FAAA repair is associated with increased blood loss and operative time. Outcomes are similar in both groups. The proximal control of the graft limb/EIA in selective instances and the intraluminal control of deep femoral artery in all patients are technical aids to assist in satisfactory outcomes. [Formula presented]

Volume

81

Issue

6

First Page

e212

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