[Graft aneurysms as long-term complication of polyester prostheses and their management : Brief review based on a systematic review of the literature]. / Graftaneurysmen als Langzeitkomplikation einer Polyesterprothese und deren Management : Kurzübersicht anhand einer systematischen Literaturanalyse.

ABSTRACT

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. AIM AND METHOD: The aim of the compact brief review was to describe the rare finding of a true aneurysm of a prosthesis and its diagnosis-specific care including a representative scientific case report, based on selected topic-related references from the medical literature as well as the specific experiences obtained from the successful clinical management in single cases. RESULTS (COMPLEX KEY POINTS ASSOCIATED WITH PATIENT AND CLINICAL FINDINGS AND CASE PRESENTATION) Out of initially 321 references found in the literature search, 20 articles published after 1995 were finally evaluated. Most frequently, pseudoaneurysms of knitted polyester prostheses at the femoropopliteal segment occurred on average after approximately 12.9 years. In one third of the cases two or more aneurysms of Dacron prostheses were described. Histological and electron microscopy investigations revealed mainly breakage of filaments and foreign body reactions. In more than half of the patients, the aneurysm was resected and for reconstruction an interposition graft was implanted. Complete removal of the prosthesis and endovascular treatment were only second choice. REPRESENTATIVE CASE A 49-year-old male patient underwent a femoropopliteal P1 prosthetic bypass of the right leg in 1997. After 19 years a true aneurysm of the prosthesis was diagnosed in the right thigh using duplex ultrasonography and complementary magnetic resonance angiography (MRA). This was successfully treated with resection of the aneurysm and insertion of an 8­mm Dacron prosthesis (Intergard Synergy Knitted, InterVascular, Bensheim, Germany). CONCLUSION: The development of true aneurysms of prostheses has not yet been satisfactorily clarified. This belongs to the profile of late complications, even if rarely and should be controlled after a postoperative interval of approximately one decade. This should be carried out by diagnostic imaging follow-up screening if the previous arterial recanalization/reconstruction could not be performed sequentially following endovascular intervention and venous-based reconstruction, other than with prosthetic material.