title: Open repair of chronic post-traumatic aneurysms of the aortic isthmus: the value of direct aortoaortic anastomosis.
abstract: OBJECTIVE
  This report presents our experience with open repair of post-traumatic aneurysms of the aortic isthmus using recent surgical techniques, including distal aortic perfusion and the preferential use of direct aortoaortic anastomosis without interposition of prosthetic material.
  
  
  METHODS
  From 1990 to 2004, the senior author (EK) patients (21 men; mean age, 40.3 years) who presented with post-traumatic aneurysms of the aortic isthmus were treated operatively, either with (20 patients) or without (3 patients) distal aortic perfusion, or endovascularly with a stent graft (3 patients). In 15 (75 %) of the 20 patients treated with distal aortic perfusion, the technique consisted of resection followed by direct aortoaortic anastomosis. Eight patients, including the three patients treated with simple clamping, had prosthetic replacement.
  
  
  RESULTS
  No postoperative deaths or permanent spinal cord complications occurred. One patient required reoperation to control hemorrhage. Aortography or computed tomography angiography was performed on 12 of the 15 patients treated by direct aortoaortic anastomosis, with a mean follow-up of 58.7 +/- 8.9 months. No morphologic abnormality was found.
  
  
  CONCLUSIONS
  This study shows that low-risk patients with a chronic post-traumatic aneurysm of the aortic isthmus can be successfully treated with excellent long-term results by resection and direct aortoaortic anastomosis without prosthetic interposition. In our opinion, endovascular repair should only be used in patients who present with absolute contraindications for open surgical repair.
authors.affiliation: Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, France. edouard.kieffer@psl.aphp.fr
authors.forename: Edouard
authors.initials: E
authors.lastname: Kieffer
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Leschi
authors.forename: Laurent
authors.initials: L
authors.lastname: Chiche
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000714:Anastomosis, Surgical; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques; D014656:Vascular Surgical Procedures