Anastomotic aneurysms

A 70-year-old woman presented with bilateral pulsatile groin masses (Fig. 10.1). Six years ago, she had an elective aorto-bifemoral graft for a 6-cm abdominal aortic aneurysm involving both iliac arteries, from which she made a full recovery. She first found the larger, right-sided mass 4 months ago, and she had noted gradual enlargement since then. She had no symptoms of claudication or leg ischemia. Her past medical history included a myocardial infarction (MI) 18 months ago, but without limitation to her exercise tolerance. On examination, she appeared well. There was a well-healed midline laparotomy scar from the previous operation. Abdominal examination was unremarkable, and there were no bruits on auscultation. Two well-defined expansile masses were palpable in the middle third of the femoral scars, measuring approximately 2 cm on the left and 4 cm on the right. The masses were not tender. There was no evidence of compromise to the distal circulation, and all pulses were palpable. Duplex imaging identified anastomotic false aneurysms in both groins, measuring 1.8 cm on the left and 3.5 cm on the right.