Endovascular treatment for para-anastomotic abdominal aortic and iliac aneurysms following aortic surgery.
OBJECTIVE
The aim of this study was to report our experience with endovascular repair of anastomotic aneurysms occurring after graft replacement for abdominal aortic aneurysms or aorto-iliac obstructive disease.


METHODS
Between January 2000 and April 2006, 19 consecutive male patients (median age 73 years) underwent endovascular repair for 22 anastomotic aneurysms [proximal aortic (n=15), iliac (n=4), concomitant aortic and iliac (n=3)], occurring 3 months to 18 years (mean 8.6 years) after open surgery. Three patients (15.7%) underwent emergency treatment for rupture. No patient had symptoms or positive blood tests for infection of the original graft. Twelve patients were treated with a bifurcated stent-graft, 4 patients with a proximal stent-graft cuff, 2 patients with a tube iliac stent-graft, and 1 patient with a mono-iliac stent-graft.


RESULTS
Stent-grafts were successfully deployed in all patients. Procedure-related complications or death were not observed; open conversion was never required. Median hospitalisation was 9 days (range 3-45). During a median follow-up of 16 Euro-months (range, 2-44) all anastomotic aneurysms maintained excluded: 4 patients (21%) died. We observed 1 major complication (5.2%): an iliac branch occlusion occurred 1 month after the procedure, successfully treated with catheter-directed thrombolysis. Overall, survival rates at 6, 12, 18 and 36-months were 92.8%, 84.4%, 72.3%, and 57.8% respectively.


CONCLUSIONS
Our experience confirms that endovascular stent-grafts can be used successfully to exclude anastomotic aortic aneurysms after open surgery. Endovascular repair seems to be effective at mid-term follow-up.
Piffaretti
G
G
Unit of Vascular Surgery, Department of Surgery, University of Insubria, Varese, Italy. gabriele.piffaretti@tiscali.it
Tozzi
M
M
Lomazzi
C
C
Rivolta
N
N
Caronno
R
R
Castelli
P
P
D000368:Aged; D000714:Anastomosis, Surgical; D015901:Angiography, Digital Subtraction; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation; D018570:Risk Assessment; D015607:Stents; D013529:Surgical Wound Dehiscence / Q000150:complications* / Q000601:surgery*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency