Endovascular treatment of anastomotic pseudoaneurysms after aorto-iliac surgical reconstruction.
OBJECTIVE
To assess the effectiveness of endovascular treatment of anastomotic pseudoaneurysms (APAs) following aorto-iliac surgical reconstruction.


METHODS
We retrospectively evaluated 21 men who, between July 2000 and March 2006, were observed with 30 APAs, 13 to the proximal anastomosis and 17 to the distal anastomosis. The patients had had previous aorto-iliac reconstructive surgery with a bypass due to aneurysm (15/21) or obstructive disease (6/21). The following devices were used: 12 bifurcated endoprostheses, 2 aorto-monoiliac, 4 aortic extenders, 1 stent-graft leg, and 2 covered stents. Follow-up was performed with CT angiography at 1, 3, and 6 months after the procedure and yearly thereafter.


RESULTS
Immediate technical success was 100%. No periprocedural complications occurred. Four patients died during follow-up from causes not related to APA, and 1 (treated for prosthetic-enteric fistula) from sepsis 3 months after the procedure. During a mean follow-up of 19.7 months (range 1-72 months), 2 of 21 occlusions of stent-graft legs occurred 3 and 24 months after the procedure (treated with thrombolysis and percutaneous transluminal angioplasty and femorofemoral bypass, respectively) and 1 type I endoleak. Primary clinical success rate was 81% and secondary clinical success was 91%.


CONCLUSIONS
Endovascular treatment is a valid alternative to open surgery and can be proposed as the treatment of choice for APAs, especially in patients who are a high surgical risk. Further studies with larger series and longer follow-up are necessary to confirm the long-term effectiveness of this approach.
Laganà
Domenico
D
Department of Radiology, University of Insubria, Viale Borri, 57, 21100 Varese, Italy. donlaga@gmail.com
Carrafiello
Gianpaolo
G
Mangini
Monica
M
Recaldini
Chiara
C
Lumia
Domenico
D
Cuffari
Salvatore
S
Caronno
Roberto
R
Castelli
Patrizio
P
Fugazzola
Carlo
C
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D017541:Aneurysm, False / Q000601:surgery / Q000628:therapy*; D000792:Angiography; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D003287:Contrast Media; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D017543:Iliac Aneurysm / Q000601:surgery / Q000628:therapy*; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids; D014654:Vascular Patency
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C057937:iomeprol; C044834:iodixanol; D007479:Iopamidol