title: Endovascular repair of proximal para-anastomotic aneurysms after previous open abdominal aortic aneurysm reconstruction.
abstract: OBJECTIVE
  To evaluate the safety, efficacy and durability of endovascular repair for proximal para-anastomotic aneurysms after previous open abdominal aortic aneurysms prosthetic reconstruction and share our experience.
  
  
  METHODS
  We retrospectively reviewed the data of all patients with previous open abdominal aortic aneurysms prosthetic reconstruction who underwent endovascular repair for proximal para-anastomotic aneurysms between May 2003 and January 2013 in our center (Nuremberg South Hospital). Key clinical outcomes included technical success rate, peri-operative morbidity and mortality, mid-term complications, reinterventions and open conversion rates.
  
  
  RESULTS
  Totally, 24 patients of proximal para-anastomotic aneurysm were treated by endovascular repair. Successful deployments of stent graft were achieved in all patients (100%). Median hospital stay was 6.7 days. One patient had minor type Ia endoleak and one patient developed wound infection. There were no early open conversions and deaths. During a median follow-up of 43 months (range, 7-67 months), computed tomography angiography revealed type Ia endoleaks in four patients (16.7%). The overall reintervention and open conversion rates during follow-up were 16.7% (4/24) and 4.2% (1/24), respectively. Estimates of freedom from reintervention were 91.7% at 1 year, 87.1% at 3 years and 80.9% at 5 years. There was significant difference in freedom from reintervention between proximal para-anastomotic aneurysms patients treated with tube and unibody bifurcated stent grafts (p = 0.034). The cumulative mortality rate was 12.5% (3/24), actuarial analysis for all patients estimated survival rates of 95.8% at 1 year and 87.3% at 5 years.
  
  
  CONCLUSIONS
  Proximal para-anastomotic aneurysms are severe complications after abdominal aortic aneurysm open reconstruction. Closer follow-up and prompt treatment are necessary. Endovascular treatment for proximal para-anastomotic aneurysms is effective, safe and durable. Unibody bifurcated stent graft proved to be suitable for most proximal para-anastomotic aneurysms with various anatomical features.
authors.affiliation: Department of Vascular and Endovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China Department of Vascular and Endovascular Surgery, Nuremberg Southern Hospital, Nuremberg, Germany.
authors.forename: Ziheng
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Vascular and Endovascular Surgery, Nuremberg Southern Hospital, Nuremberg, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Raithel
authors.affiliation: Department of Vascular and Endovascular Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China qulefengsubmit@163.com.
authors.forename: Lefeng
authors.initials: L
authors.lastname: Qu
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D000072226:Computed Tomography Angiography; D018572:Disease-Free Survival; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Proximal para-anastomotic aneurysm; abdominal aortic aneurysm; endovascular repair; stent graft