Graft aneurysm as long-term complication of a polyester prosthesis and its adequate management - short review based on a systematic review of literature and a representative case report

Introduction

A material-associated true aneurysm after previous use of a vascular prosthesis for arterial reconstruction mostly in peripheral arterial occlusion disease (PAOD) is considered a rare but serious complication.

Case description

A 49 year old male patient underwent several sequential steps of arterial recanalization/reconstruction because of PAOD, stage IIb (walking distance, <100m) according to local findings with endovascular measures and vascularsurgical bypass implantation by means of a femoropoliteal P1-prosthetic bypass at the right and left leg (the right distal prosthetic segment was extended with a venous bypass to the P3-segment because of a distal suture aneurysm and arterial thrombosis of the right calf. After 10 years, a true prosthetic aneurysm was diagnosed at the right thigh using Duplex-ultrasonography and complementary MR-angiography. It was successfully treated with a femoro(prosthetico)-infragenual 6-mm-Gore^®-Propaten^® bypass (W.L. Gore, Putzbrunn, Germany) down to the P3-segment of the right popliteal artery. Nineteen articles were found in the literature search, which had been published since 1995. Most frequently, pseudoaneurysms of knitted polyester prostheses at the femoro-popliteal segment occurred after approximately 12.91 years in average. In one third of cases, 2 ore more aneurysms of dacron prostheses were described. Histological and electromicroscopic investigations revealed mainly breakings of filaments and foreign body reactions. In more than half of the patients, the aneurysm was resected and for reconstruction, an interponate was implanted. Complete removal of the prosthesis and endovascular therapy were only 2nd choice.

Results and Conclusions

Development of true prosthetic aneurysms has not been satisfyingly clarified yet. It belongs to the late complication profile - even it occurs rarely - and should be controlled after a postoperative interval of one decade if the arterial recanalization/reconstruction was performed using prosthetic material after previously - in the sequential approach - endovascular intervention and venous bypass could not be used.