Yonsei Med J.  2009 Apr;50(2):227-238.

Uninfected Para-Anastomotic Aneurysms after Infrarenal Aortic Grafting

• Bianchi P
• Nano G
• Cusmai F
• Ramponi F
• Stegher S
• Dell'Aglio D
• Malacrida
• Tealdi DG

Abstract

PURPOSE
This single-institution retrospective review examines the management of uninfected para-anastomotic aneurysms of the abdominal aorta (PAAA), developed after infrarenal grafting. MATERIALS AND METHODS: From October 1979 to November 2005, 31 PAAA were observed in our Department. Twenty-six uninfected PAAA of degenerative etiology, including 24 false and 2 true aneurysms, were candidates for intervention and retrospectively included in our database for management and outcome evaluation. Six (23%) patients were treated as emergencies. Surgery included tube graft interposition (n = 12), new reconstruction (n = 8), and graft removal with extra-anatomic bypass (n = 3). Endovascular management (n = 3) consisted of free-flow tube endografts. RESULTS: The mortality rate among the elective and emergency cases was 5% and 66.6%, respectively (p = 0.005). The morbidity rate in elective cases was 57.8%, whereas 75% in emergency cases (p = 0.99). The survival rate during the follow-up was significantly higher for elective cases than for emergency cases. CONCLUSION: Uninfected PAAA is a late complication of aortic grafting, tends to evolve silently and is difficult to diagnose. The prevalence is underestimated and increases with time since surgery. The mortality rate is higher among patients treated as an emergency than among patients who undergo elective surgery, therefore, elective treatment and aggressive management in the case of pseudoaneurysm are the keys to obtain a good outcome. Endovascular treatment could reduce mortality. Patients who undergo infrarenal aortic grafting require life-long surveillance after surgery.

Keyword

Abdominal aortic grafting; pseudoaneurysm; anastomotic aneurysm; para-anastomotic aneurysm; endograft

MeSH Terms

Aged
Aneurysm, False/surgery
Aneurysm, Infected/pathology/*surgery
Aorta, Abdominal/pathology/surgery
Aortic Aneurysm, Abdominal/*surgery
*Blood Vessel Prosthesis Implantation
Female
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 Kaplan-Meier product-limit survival estimates of the overall population of uninfected PAAA. PAAA, para-anastomotic aneurysm of the abdominal aorta.

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  Fig. 2 Kaplan-Meier product-limit survival estimates comparing elective vs. emergency cases.

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  Fig. 3 Kaplan-Meier product-limit survival estimates comparing surgical vs. endovascular cases.

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