Suture Material as a Factor in the Occurrence of Anastomotic False Aneurysms: An Analysis of 26 Cases

False aneurysm formation is a well-recognized late complication of prosthetic graft insertion. Despite the fact that other etiologic factors may be involved, the behavior of the suture material remains of central importance. In a retrospective review of 1,330 peripheral vascular cases, we found 26 cases involving a total of 39 false aneurysms, or an incidence of 2% (26/1,330). Twenty-four of these were directly attributable to failure of the monofilament plastic suture or silk suture material. Braided Dacron suture was used in the original anastomosis in another seven cases, and in these instances the false aneurysms were not related to suture failure but were associated with such factors as previous endarterectomy, failure of arterial wall, and chronic hypertension. None of the 39 aneurysms was secondary to infection or trauma. These results emphasize the importance of using a braided, nonabsorbable suture material to ensure the continued integrity of an anastomosis involving prosthetic grafts.