CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 48 AFRICA Aneurysmal degeneration in the Omniflow II biosynthetic vascular graft Ismail Selçuk, Bülent Bariş Güven Abstract Despite advances in endovascular treatments, femoropopliteal bypass is still the best option for the treatment of lower-extremity occlusive artery disease. Omniflow II biosynthetic vascular grafts are often chosen as bypass grafts when autologous vein grafting is not possible. A negative feature of this graft is the tendency towards late biodegeneration with possible formation of graft aneurysms. In this case report, we present a thrombosed non-anastomotic biosynthetic graft aneurysm, which caused only a pulsatile mass in the inguinal region, in a 62-year-old male patient who had undergone a femoropopliteal bypass operation three years earlier. Aneurysm formation in vascular grafts is multifactorial and can cause life-threatening consequences. Therefore, all patients with biosynthetic vascular grafts should remain under lifetime surveillance with duplex ultrasound for aneurysmal graft degeneration and graft thrombosis. Keywords: peripheral arterial disease, grafts, aneurysm Submitted 9/11/21, accepted 8/1/22 Published online 28/1/22 Cardiovasc J Afr 2023; 34: 48–50 www.cvja.co.za DOI: 10.5830/CVJA-2022-004 Despite advances in endovascular treatments, femoropopliteal bypass is still the best option for the treatment of lowerextremity occlusive artery disease. The great saphenous vein is the autogenous graft of choice for infra-inguinal reconstructions but is not always suitable for grafting. In these cases, arterial reconstruction using a prosthetic graft is an option.1,2 Synthetic and biological vascular grafts have been used since the 1950s.3 Over time, synthetic grafts tend to increase rather than decrease their thrombogenic potential with neo-intimal formation. Therefore, biological grafts have become an alternative to synthetic grafts for peripheral arterial disease. For various reasons, most biological grafts have been withdrawn from the market and Omniflow® II (Bio Nova International, Victoria, Australia) is currently the only biological vascular prosthesis (OBVG) available for peripheral revascularisation.1 A negative feature of the OBVG is the tendency toward late biodegeneration with possible formation of graft aneurysms.1-4 Surprisingly, data about late outcome and possible biodegeneration of the OBVG are scarce in the literature. In this case, we report symptomatic spontaneous true aneurysm of an OBVG in a patient with generalised atherosclerosis. Case report TheOBVGhadbeeninsertedinthe leftabove-kneefemoropopliteal location of a 62-year-old male patient due to peripheral artery disease three years earlier. The patient received dual antiplatelet treatment (clopidogrel 75 mg/day + acetylsalicylic acid 100 mg/ day) for the first three months postoperatively, and then regularly used acetylsalicylic acid 300 mg/day. Sultan 2 Abdulhamid Han Training and Research Hospital, Istanbul, Turkey Ismail Selçuk, MD Bülent Barış Güven, MD, barguv@gmail.com Fig. 1. Aneurysmatic three-dimensional computed tomography view of the left femoral artery vascular biosynthetic graft (Omniflow II). A. View of organised thrombus (black arrows) removed from vascular graft. B. Aneurysm sac after aneurysmectomy. A B
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