Pseudo aneurysm of a 21 year old ePTFE femoro-femoral crossover graft: successful endovascular repair using an ePTFE lined nitinol stent graft.

With the advancement of technology and manufacturing of prosthetic grafts, non- anastomotic pseudoaneurysm arising from a graft is now uncommon. Here we report a case of non-anastomotic pseudo aneurysm occurring 21 years after implantation of ePTFE femoro-femoral crossover graft. An 80 year old female with a previous history of a femoro- femoral cross-over bypass surgery performed using a10 mm reinforced polytetrafluoroethylene graft presented with a pulsatile lump in her right groin. CT angiography showed a fusiform type non-ruptured false aneurysm of 6.4 cm maximum diameter and was arising directly from the graft. Because of the risk of rupture, the patient was treated endovascularly with 13 mm * 8 cm Viabahn self-expanding covered stent across the pseudo aneurysm. The final angiographic results were excellent and showed resolution of the aneurysm with good flow through the graft and distal vessel. This type of complication is easily diagnosed by clinical examination and imaging studies, which display an aneurysm of the graft remote from the anastomosis. Percutaneous intervention with covered stent may offer an easy and safe way to treat this type of aneurysm.