SUCCESSFUL TREATMENT OF PSEUDOANEURYSM OF THE PROXIMAL ANASTOMOSIS OF THE AORTO-BIFEMORAL BYPASS GRAFT COMPLICATED BY NECROSIS OF THE SIGMOID COLON WALL

Ignatiev I.M., Gaptravanov A.G., Salimov D.R., Akhmetzyanov R.V.
Department of Vascular Surgery, Interregional Clinical and Diagnostic Centre,
Kazan, Russia

The article describes a case report of successful surgical management of a 58-year-old male patient presenting with a pseudoaneurysm of the proximal anastomosis of the aorto-bifemoral bypass graft complicated by necrosis of the sigmoid colon wall.

The patient was operated on 11 months after the first reconstructive operation, i.e. aorto-bifemoral bypass grafting and femoropopliteal bypass grafting for Leriche 's syndrome. Clinical manifestations of a false aneurysm of the proximal anastomosis (abdominal pain, presence of a pulsating tumour-like formation) appeared one month after surgery.

The diagnosis was verified by ultrasonography, angiography, and CT-angiography. During the repeat operation, it was determined that a large false aneurysm of the abdominal aorta had been caused by a complete cutting through of the anastomosis's sutures more than by half of the semicircle. Intraoperative findings included both a coarse commissural process in the abdominal cavity and 3x3 cm "decubital" necrosis of the dolichosigmoid's wall participating in the formation of the wall of the false aneurysm. The surgical procedure consisted in an operation of aneurysmal resection, aorto-bifemoral prosthetic repair, and resection of the dolichosigmoid with the establishment of an interintestinal end-to-side anastomosis and single-barrel preventive sigmoidostoma. After 3 months, the patient was subjected to the operation of intraperitoneal closure of the sigmoidostoma followed by complete recovery.

KEY WORDS: false aneurysm of a proximal anastomosis, necrosis of the sigmoid colon wall, aorto-bifemoral prosthetic repair, sigmoidostoma.

P. 130-133

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