Results of vascular reconstruction for false peripheral arterial aneurysms

INTRODUCTION. Shrapnel wounds during combat may damage peripheral arteries. In some cases, a false aneurysm is formed. Surgical reconstruction of the vessel after its removal is reduced to two surgical techniques – autovenous saphenous prosthetics and end-to-end anastomosis.

The OBJECTIVE was to analyze the results of various surgical treatment techniques for removing a false peripheral arterial aneurysm in a military field hospital in a special military operation zone.

METHODS AND MATERIALS. During the period from 01.02.2025 to 01.08.2025, 22 reconstructive interventions were performed in the military field hospital in the special military operation zone for the development of a false peripheral arterial aneurysm after a shrapnel wound to the limb. Depending on the chosen surgical technique, all patients were divided into two groups: Group 1 – autovenous saphenous prosthetics with a reversed great saphenous vein (GSV), n=11; Group 2 – end-to-end anastomosis between arterial stumps, n=11.

RESULTS. Acute arterial thrombosis was observed in 3 (20 %) patients in Group 1 and 1 (6.7 %) patient in Group 2. Arteriovenous fistula was detected in 2 (13.3 %) patients and 1 (6.7 %) patients, respectively. In the vast majority of cases, the false aneurysm diameter was 3–5 cm. In all cases, mural thrombotic masses were visualized. The localization sites of pathology in the total sample (n=30) were: n=4 (13.3 %) – axillary artery; n=4 (13.3 %) – brachial artery; n=4 (13.3 %) – posterior tibial artery; n=3 (10.0 %) – popliteal artery; n=2 (6.7 %) – superficial femoral artery; 1 case each (3.3 %) – ulnar artery, radial artery, common femoral artery, deep femoral artery, peroneal artery. The average operation time in the first group was 226.5±24.8 minutes, in the second – 115.7±31.4 minutes (p=0.03). Autovenous grafting of the reversed GSV was performed only in patients with damage to the axillary artery (n=4, 26.7 %), brachial artery (n=4, 26.7 %) and popliteal artery (n=4, 20 %). End-to-end anastomosis was performed in cases of damage to the posterior tibial artery (n=4, 26.7 %), superficial femoral artery (n=2, 13.3 %), common femoral artery (n=1, 6.7 %), deep femoral artery (n=1, 6.7 %), peroneal artery (n=1, 6.7 %), ulnar artery (n=1, 6.7 %), radial artery (n=1, 6.7 %). During 30 days of postoperative observation, no deaths, thrombosis of the reconstruction zone, or infectious complications were recorded. Symptoms of acute ischemia and limb edema completely regressed in all cases.

CONCLUSION. The implementation of autovenous grafting and end-to-end anastomosis after removal of a false peripheral arterial aneurysm is an effective and safe treatment method.

1. Muminzhonova MMK, Antonov GI, Chmutin GE, et al. Gunshot injuries of the extracranial part of the carotid basin with the formation of a false aneurysm. Clinical observation of staged treatment and literature review. Bulletin of Neurology, Psychiatry and Neurosurgery. 2025; 18(4 (183)): 480 – 492. DOI: 10.33920/med-01-2504-07

2. Kharchenko OYu, Kazantsev AN, Alekseev OV, et al. Resection of false posttraumatic aneurysm of the axillary artery within a separate medical airmobile detachment in special military operation zone. Pirogov Russian Journal of Surgery. 2025;(6):122 127. https://doi.org/10.17116/hirurgia2025061122

3. Seliverstov PA, Shapkin YuG. Application of damage control tactics in combat injuries of the extremities at the forefront of medical evacuation in modern wars (literature review). Medical, biological and socio-psychological problems of safety in emergency situations. 2023; 1: 42-52. DOI: 10.25016/2541-7487-2023-0-1-42-52

4. Kabirov AV, Vasin AS, Grachev AM et al. Thromboembolism of the palmar arches, digital arteries against the background of posttraumatic aneurysm of the left brachial artery. Angiology and vascular surgery. Journal named after academician A.V. Pokrovsky. 2013; 19(2): 147-151.

5. Burkov NN, Kazantsev AN, Anufriev AI, et al. Results of femoral and tibial reconstruction with biological prosthesis "Kemangioprosthesis". Cardiology and cardiovascular surgery. 2020; 13(1): 29-35. DOI: 10.17116/cardio20201301129

6. Zakeryaev AB, Vinogradov RA, Sukhoruchkin PV, Butaev SR. Femoropopliteal bypass. Cardiology and cardiovascular surgery. 2023; 16(3): 272-282. DOI: 10.17116/kardio202316031272

7. Kazantsev A.N., Burkov N.N., Bayandin M.S., Guselnikova Yu.I. Late complication of iliofemoral arthroplasty: giant pseudoaneurysm of the prosthesis branch in the area of the distal anastomosis. Surgery. Journal im. N.I. Pirogov. 2021; 3: 73-77. DOI: 10.17116/hirurgia202103173