Prise en charge des faux anévrysmes artériels traumatiques et iatrogènes en milieu tropical

A false aneurysm or pseudoaneurysm (PA) is the formation of a pulsatile and encapsulated hematoma in communication with the lumen of a perforated artery. Its origin is different but most cases are associated with a traumatic event. Currently, the referenced treatment is endovascular surgery but it is not feasible for the majority of vascular surgeons working in a tropical environment. The aim of this study was to describe the diagnostic and therapeutic aspects of arterial PA (APA) encountered in our institution and to evaluate the place of open surgical technique in their management. This was a 30-month retrospective and descriptive study carried out in our institution (CHU-JRA, Antananarivo, Madagascar). Between 2012 and 2014, ten cases of APA were operated. There were 8 men with an average age of 30 years. The etiologies were accidental trauma (n = 6) or iatrogenic vascular injury (n = 4). Most patients had a painful and pulsatile swelling (n = 8). The presence of a wound scar located on the swelling was observed in 5 patients. The false aneurysms were localized in the radial (n = 3), femoral (n = 2), brachial (n = 2), carotid (n = 2) and ulnar (n = 1) arteries. The diagnosis was confirmed by ultrasound Doppler in all patients. The treatment was an open surgical procedure and consisted of lateral suture (n = 4), resection with direct end-to-end anastomosis (n = 1) or using autologous saphenous vein graft (n = 2) or ligation (n = 3). Postoperative courses and outcomes at last follow-up were uneventful with optimal patency rate.