A Case of Non-Anastomotic Pseudoaneurysm without External Factors after Femoral Artery-Above-Knee Popliteal Artery Bypass Used ePTFE Graft

Abstract

The patient was an 80-year-old male who had undergone a left femoral artery-above-knee popliteal artery bypass using an ePTFE graft thirteen years prior. The patient was admitted to our hospital with swelling of the left thigh. Despite the absence of hemorrhages on lower limb arterial echo and contrast enhanced CT, surgical intervention was deemed necessary due the swelling of the left thigh and an increase in the low-density area (LDA) observed during follow-up. The LDA, confirmed by the contrast-enhanced CT, was a hematoma, and the ePTFE graft is kinked at 2 points. Additionally, the ring of the ePTFE graft had dislodged a crack was detected in the flexural area, and bleeding was observed in the same region, depending on the degree of flexion. Given the complexity of the direct repair of the ePTFE graft itself, an interposition was performed using a FUSION 7 mm graft. Postoperatively, wound healing was taken time, but no rebleeding occurred, and the patient was subsequently discharged. This case suggests that intermittent bending of the ePTFE graft due to leg flexion and extension, dislodging of the ring due to degrade, and hardening of the ePTFE graft were contributory factors to the rupture of itself.