Giant Pseudoaneurysm as an Uncommon Late Complication Following a Fourteen-Year Femoropopliteal Bypass in a Visually Impaired Patient.

Background

Non-anastomotic pseudoaneurysm formation due to very late prosthetic graft failure after femoropopliteal bypass is exceptionally rare. Case Presentation: We describe a 73-year-old blind man who presented with rapid enlargement of a mid-thigh mass on the left side, associated with skin necrosis. His history included advanced atherosclerosis with bilateral superficial femoral artery occlusion and prior femoropopliteal bypasses: a right-sided great saphenous vein graft (2006) and a left-sided Dacron® graft (2008). Computed tomography angiography revealed a giant pseudoaneurysm originating from the mid-portion of the left bypass graft (13.8 × 16.5 cm) with active contrast extravasation and distal popliteal artery occlusion, as well as a large, well-defined lateral thigh lipoma. Open surgery revealed structural graft disruption within the prosthetic body and a large chronic pseudoaneurysm sac containing organized thrombus. En bloc pseudoaneurysm excision and graft exclusion without reconstruction were performed, followed by soft-tissue reconstruction. The postoperative course was uneventful, with complete wound healing by four weeks and no ischemic symptoms during 18 months of follow-up. This exceptionally late prosthetic graft complication underscores the need for long-term surveillance in patients with lower-limb bypass grafts.

Conclusions

This case highlights that prosthetic graft failure may occur very late and present insidiously. Recognition of this rare complication is essential for timely diagnosis and individualized surgical management.