What is the most common complication of an aortic graft?

• A. Aneurysm
• B. Pseudoaneurysm
• C. Hematoma
• D. Stenosis

Answer: (B)

A contained leak at the graft anastomosis—a pseudoaneurysm—is the most common complication after an aortic graft. Blood escapes through the suture line but is confined by surrounding tissue, forming a sac that remains connected to the graft lumen. On duplex ultrasound, you’d see a pulsatile sac adjacent to the graft with a narrow neck connecting to the graft. The hallmark is to-and-fro flow in the neck on spectral Doppler, with bidirectional color flow in the neck and blood swirling into and out of the sac with each heartbeat. This pattern distinguishes it from a simple hematoma, which lacks communication with the graft and the characteristic neck flow, and from stenosis, which presents as a narrowed segment with a high-velocity jet rather than a separate sac. Recognizing this finding is important because a growing pseudoaneurysm can rupture and require urgent management.