Endograft treatment of anastomotic aneurysms following conventional open surgery for infrarenal aortic aneurysms.
OBJECTIVE
to evaluate the use of endograft therapy for treating anastomotic aneurysm following open surgical repair of infrarenal aneurysms of the abdominal aorta.


METHODS
four male patients (age 47-75 years) at high surgical risk (ASA IV n=3, ASA III n=1) developed secondary aneurysms at the site of the central (four aneurysms) and additional peripheral (two aneurysms) anastomosis of their tube or bifurcation prosthesis an average of 13 years (range 1-23 years) after conventional open surgical correction of infrarenal aneurysm of the abdominal aorta. In two patients, there was covered rupture of the aneurysm sac. The aneurysm diameter was 4.8 cm, 8.0 cm, 7.4 cm, 7.0 cm, respectively (mean 6.8 cm). Follow-up included helical CT imaging at 1 week, 3 months and 6 months postoperatively.


RESULTS
anastomotic aneurysm was successfully treated in all four cases. No evidence of endoleak was observed during the follow-up period. Two patients died 14 and 18 days after surgery due to myocardial infarction and cerebrovascular accident. The endovascular repair of the two patients who died was intact.


CONCLUSIONS
although no long-term results are available, the use of a graft-in-graft method to repair anastomotic aneurysms following conventional implantation of tube or bifurcation prostheses appears to be effective, particularly in patients at high surgical risk.
Liewald
F
F
Department of Thoracic and Vascular Surgery, University of Ulm, Steinhövelstr. 9, 89075 Ulm, Germany.
Kapfer
X
X
Görich
J
J
Halter
G
G
Tomczak
R
R
Scharrer-Pamler
R
R
D000368:Aged; D000714:Anastomosis, Surgical; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed