title: Graft-related complications after abdominal aortic aneurysm repair: reassurance from a 36-year population-based experience.
abstract: OBJECTIVE
  Graft-related complications must be factored into the long-term morbidity and mortality rates of abdominal aortic aneurysm (AAA) repair. However, the true incidence may be underestimated because some patients do not return to the original surgical center when a problem arises.
  
  
  METHODS
  To minimize referral bias and loss to follow-up, we studied all patients who underwent AAA repair between 1957 and 1990 in a geographically defined community where all AAA operations were performed and followed by a single surgical practice. All patients who remained alive were asked to have their aortic grafts imaged.
  
  
  RESULTS
  Among 307 patients who underwent AAA repair, 29 patients (9.4%) had a graft-related complication. At a mean follow-up of 5.8 years (range, < 30 days to 36 years), the most common complication was anastomotic pseudoaneurysm (3.0%), followed by graft thrombosis (2.0%), graft-enteric erosion/fistula (1.6%), graft infection (1.3%), anastomotic hemorrhage (1.3%), colon ischemia (0.7%), and atheroembolism (0.3%). Complications were recognized within 30 days after surgery in eight patients (2.6%) and at late follow-up in 21 patients (6.8%). These complications were observed at a median follow-up of 6.1 years for anastomotic pseudoaneurysm, 4.3 years for graft-enteric erosion, and 0.15 years for graft infection. Kaplan-Meier 5- and 10-year survival free estimates were 98% and 96% for anastomotic pseudoaneurysm, 98% and 95% for combined graft-enteric erosion/infection, and 98% and 97% for graft thrombosis.
  
  
  CONCLUSIONS
  This 36-year population-based study confirms that the vast majority of patients who undergo standard surgical repair of an abdominal aortic aneurysm remain free of any significant graft-related complication during their remaining lifetime.
authors.affiliation: Division of Vascular Surgery, Mayo Foundation, Rochester, MN 55905, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Hallett
authors.forename: D M
authors.initials: DM
authors.lastname: Marshall
authors.forename: T M
authors.initials: TM
authors.lastname: Petterson
authors.forename: D T
authors.initials: DT
authors.lastname: Gray
authors.forename: T C
authors.initials: TC
authors.lastname: Bower
authors.forename: K J
authors.initials: KJ
authors.lastname: Cherry
authors.forename: P
authors.initials: P
authors.lastname: Gloviczki
authors.forename: P C
authors.initials: PC
authors.lastname: Pairolero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000401:mortality; D003106:Colon / Q000098:blood supply; D005260:Female; D005402:Fistula / Q000209:etiology; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D007511:Ischemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D016459:Prosthesis-Related Infections; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology; D014481:United States / Q000453:epidemiology