Uninfected para-anastomotic aneurysms after infrarenal aortic grafting.
OBJECTIVE
This single-institution retrospective review examines the management of uninfected para-anastomotic aneurysms of the abdominal aorta (PAAA), developed after infrarenal grafting.


METHODS
From October 1979 to November 2005, 31 PAAA were observed in our Department. Twenty-six uninfected PAAA of degenerative etiology, including 24 false and 2 true aneurysms, were candidates for intervention and retrospectively included in our database for management and outcome evaluation. Six (23%) patients were treated as emergencies. Surgery included tube graft interposition (n = 12), new reconstruction (n = 8), and graft removal with extra-anatomic bypass (n = 3). Endovascular management (n = 3) consisted of free-flow tube endografts.


RESULTS
The mortality rate among the elective and emergency cases was 5% and 66.6%, respectively (p = 0.005). The morbidity rate in elective cases was 57.8%, whereas 75% in emergency cases (p = 0.99). The survival rate during the follow-up was significantly higher for elective cases than for emergency cases.


CONCLUSIONS
Uninfected PAAA is a late complication of aortic grafting, tends to evolve silently and is difficult to diagnose. The prevalence is underestimated and increases with time since surgery. The mortality rate is higher among patients treated as an emergency than among patients who undergo elective surgery, therefore, elective treatment and aggressive management in the case of pseudoaneurysm are the keys to obtain a good outcome. Endovascular treatment could reduce mortality. Patients who undergo infrarenal aortic grafting require life-long surveillance after surgery.
Bianchi
Paolo
P
Department of Vascular Surgery, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Italy. pabi.guy74@gmail.com
Nano
Giovanni
G
Cusmai
Francesco
F
Ramponi
Fabio
F
Stegher
Silvia
S
Dell'Aglio
Daniela
D
Malacrida
Giovanni
G
Tealdi
Domenico G
DG
D000368:Aged; D017541:Aneurysm, False / Q000601:surgery; D000785:Aneurysm, Infected / Q000473:pathology / Q000601:surgery*; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome