1. Recurrent Aorto-iliac mycotic false aneurysm
Dr Jaffer Suleiman Dawood
Dept Vascular surgery
Royal Hospital

2. Challenging YEARS
Past history
schistosomiasis -- Childhood
urology follow up

3. 16 Nov 2009
Leaking large infra renal mycotic AAA

6. 1 st Repair
Laprotomy &
Aorto-Bifemural graft

7. over three years presented repeatedly & acutely with recurrent anastomotic pseudoaneurysms of the groins and abdomen
Required major revision .

8. 5 months latter ----(April 2010 )
Right groin pulsatile swelling
U/S &
CT Angio- 4.5 x 4.6 cm
Pseudoaneurysm with
Mural thrombus

9. 2 nd surgery Right limb of ABF graft was Shortened & Anastamosed
to Right external Iliac
Repair of CFA , SFA , PFA
vein patch

10. Post OP
No Recurrance

11. After 1 months -- May 2010
(After 6 months from 1 st operation )
Painful pulsatile Left groin swelling
U/S --5x3x3 cm
CT Angio- 3.5 x 3.6 cm
Pseudoaneurysm with
Partial thrombosis

12. Left groin

13. The 3 rd surgery ( May 2010 ) Repair done by :
Shortening Left limb of ABF graft & continuity restored with Reversed great saphenious vein graft which was distally
Anastamosed to SFA & PFA

14. In October 2010 (After 11 months from 1 st operation)
5 months after surgery on left groin
Second Left groin pulsatile swelling

15. U/S large 8x 9 cm
CT Angio- 8.5 x 7.6 cm
Pseudoaneurysm with
Mural thrombus

16. Was Arising from anastamotic line between the left Dacron limb and the inter positioned great Saphnous vein graft.

17. 4 th Repair 10 th october 2010
Exploration of the pseudoaneurysim done .
Continuty of flow restored with reversed superficial femoral vein

18. 13 months latter from 4 th operation (After 24 months from 1 st op )
Presented with .
lower abdominal pain
CT Angio—6.5 x5 cm saculler
Pseudoaneurym of the
Left limb of the graft .

20. 5 th intervation 19 Nov 2011 Ligation left graft limb
Axillo –Unifem bypass

21. 3 months from 5 th operation (After 27 months from 1 st operation)
pulsatile swelling in the left infra clavicular region
CT Angio—2.5 x2.3 cm
Pseudoaneurym with wide neck

22. Small adjacent haematoma seen
No active leak
Graft occluded in the medial and distally parts

23. 6 th intarvation ------22 Feb 2012
Small aneurysm of the right iliac artey
Removal of old aorto- bifemural graft (where the left limb was ligated before )
Removal of axillo-unifem graft

24. Implantation of new silver coated aorto-bifemural graft
Repair of subclavian
Pseudoaneurysm with
Vein patch

25. 7 months latter (After 34 months from 1 st op )
Left groin pulsatile painful swelling
CT Angio—4.7 x4.2x35 Pseudoaneurysm of left CFA
Repaired with Reversed Vein graft

26. Multiple admissions and procedures . ? Castleman syndrom.
Several histology were not conclusive .
Blood cultures –staph epid
Consultations with infection disease team
Closely followed by Rh team asked for cascade of investigations which were negative .
He never complaned --

27. CRP & ESR Monitoring

28. Behcet disease ? Currently Admitted.
No clinical symptoms apart from this CT finding & multiple aphthous ulcers
Started on steroids
Waiting for stanting

29. Thank you