Surgical images: soft tissue. Recurrent aneurysms

Five years after surgical repair of an infrarenal aortic aneurysm, a 64-year-old man presented with pulsatile abdominal masses located in both lower abdominal quadrants. He had a history of myocardial infarction in 1974, coronary artery bypass surgery 8 years later and a second bypass procedure for recurrent angina in 1994. The infrarenal aortic aneurysm was repaired with a straight graft (Fig. 1, panel A), excluding the iliac bifurcation. The patient still had Canadian Cardiovascular Society class II angina and reversible inferior ischemia on thallium-Persantine scanning. Nuclear magnetic imaging (NMI) showed an 8-cm left common iliac and a 4-cm right common iliac aneurysm (Fig. 1, panel A).