[Study on developmental factors in anastomotic aneurysms].

Abstract

All clinical cases of vascular reconstruction were reviewed to determine the various cases of anastomotic aneurysm. The subjects were all in-patients between 1963 and 1984 whose clinical courses were observed for more than 5 years following vascular reconstruction. Anastomotic aneurysms were found in 17 (6.4%) out of the 267 regions of anastomosis. These aneurysms were further studied by classifying them according to suture materials, primary cause of diseases, synthetic grafts and anastomotic regions, etc. The incidence of anastomotic aneurysms was lower when non-absorptive synthetic fibers were used. There was less frequency of anastomotic aneurysms when double velour Dacron was used for synthetic grafts. Due to the small number of cases, it was difficult to evaluate synthetic grafts when anastomosis was completed past the point of articulation, however the results obtained by velour type synthetic grafts were seemingly favorable. The results were not favorable, however, when end to side anastomosis was performed, since anastomotic aneurysm developed past the point of articulation in most cases. Thus the latter was conceivably responsible for the development of this disease. The findings of this research seem to indicate that the condition of the existing blood vessels is of more important consideration than the synthetic material used. In other words, examination of in vivo blood vessels for weaknesses due to degeneration and thromboendarterectomy is necessary. Thus, the region for the placement of synthetic grafts must be carefully selected. Also worthy of consideration is the intensity of the outer layers of the synthetic grafts whose organization may have been compromised to some extent in favor of an improved patency ratio, particularly in recent years.