DUPLEX SCANNING IN THE DIAGNOSIS OF FALSE ANEURYSMS OF VASCULAR ANASTOMOSES

S.A. Dadvani, Ye.G. Artyukhina, D.A. Ulyanov, A.K. Grigoryev, K.B. Frolov, B.A. Dzhachvliani, V.V. Komarov
Department of Vascular Surgery, Faculty Surgery Clinic,
I.M. Sechenov Moscow Medical Academy,
Moscow, Russia

From 1983 to 1997 altogether 584 reconstructive operations on the aortofemoral arterial segment were performed at our clinic. The longterm follow-up of patients was based on general clinical examinations including ultrasonography (US) which revealed false aneurysms of distal andproximal anastomoses in 8 patients (1.4%). In 4 patients with uncomplicated false aneurysms, B-mode US showed round or oval hypoechoic structures at the site of distal anastomosis, which were lined with thrombotic masses seen as immobile echopositive formations. The superficial and deep femoral arteries digressing from the aneurysm could be visualized in the distal direction and their status evaluated. Color Doppler Imaging and pulse Doppler demonstrated inside the aneurysm a turbulent blood flow with the low peak systolic velocity which was much higher (more than 2 m/s) in the proximal parts of the deep femoral artery. The coexistence of an anastomotic aneurysm with stenosis or occlusion of the downstream arterial bed resulted in a dramatic decrease of blood flow in the distal parts and pronounced lower limb ischemia. In contrast to X-ray angiography, US enables revealing the signs of suture failure in anastomosis. In the event of total anastomosis failure, the detached end of the synthetic graft was visualised inside the aneurysmal sac. Rupture of a false aneurysm complicated by massive bleeding and formation of retroperitoneal hematomas was diagnosed in 2 patients. One patient was recognised to have aneurysmal slight tear and one thrombosis of the aneurysm and graft. US had a diagnostic accuracy of 100%.

P. 48-57

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