title: Endovascular treatment for para-anastomotic abdominal aortic and iliac aneurysms following aortic surgery.
abstract: 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.
authors.affiliation: Unit of Vascular Surgery, Department of Surgery, University of Insubria, Varese, Italy. gabriele.piffaretti@tiscali.it
authors.forename: G
authors.initials: G
authors.lastname: Piffaretti
authors.forename: M
authors.initials: M
authors.lastname: Tozzi
authors.forename: C
authors.initials: C
authors.lastname: Lomazzi
authors.forename: N
authors.initials: N
authors.lastname: Rivolta
authors.forename: R
authors.initials: R
authors.lastname: Caronno
authors.forename: P
authors.initials: P
authors.lastname: Castelli
mesh_terms: 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