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Endovascular Repair is an Effective Alternative to Open Surgery for Para-Anastomotic Aortic Pseudoaneurysms

Division of Vascular and Endovascular Surgery, University of South Florida, Tampa, FL; mshames{at}hsc.usf.edu

Paul A. Armstrong, DO

Jeffrey S. Wilson, MD

Martin R. Back, MD

Brad L. Johnson, MD

Dennis F. Bandyk, MD

Division of Vascular and Endovascular Surgery, University of South Florida, Tampa, FL

Endovascular repair of abdominal aortic aneurysms continues to evolve as an alternative to open repair. After open aortic grafting, re-operation to repair anastomotic pseudoaneurysms is associated with significant morbidity and mortality. We reviewed our experience with the repair of para-anastomotic aortic pseudoaneurysms, including the feasibility of endovascular repair, its technical success, and outcome compared with conventional surgery. During a 10-year period, 1 1 patients (10 men, 1 woman) had repair of a para-anastomotic pseudoaneurysm (mean 7 cm; diameter range, 4.5-9 cm) involving the infrarenal aorta. Four pseudoaneurysms developed after infrarenal aortic aneurysm repairs and 7 after bypass for occlusive disease. The mean time to aneurysm development was 6 years. The decision for surgical (interposition polyester grafting) versus endovascular therapy was based on aortic anatomy, endograft availability, and surgeon preference. Endovascular repair was feasible and technically successful in 5 patients. All but one patient treated after the introduction of endovascular aneurysm repair at our institution (December 1999) was treated by this technique. Blood loss was significantly greater in the open surgical group (3000 mL vs 300 mL). The mean intensive care unit and hospital stay (days) was less in the endovascular group (0.8, 2.8) than in the surgical (4, 11) group. Thirty-day morbidity was similar for both treatment groups (endovascular, 1; surgery, 1), and no patient died in either group. During a mean follow-up of 20 months (range, 5-42 months), aortic imaging demonstrated one type II endoleak; which was successfully treated by translumbar embolization, and aneurysm diameter reduction in all endovascularly treated patients. During the surveillance period, no clinical signs of graft infection or recurrent aneurysm were evident in any patient in either treatment group. Endovascular repair of aortic graft para-anastomotic pseudoaneurysms is feasible and associated with more favorable outcomes than open surgical repair. When the aortic anatomy indicated endovascular therapy was a treatment option, endovascular repair was preferred by the surgeon and patient because of perceived reduced morbidity and shorter hospitalization than conventional surgery. To date, endovascular repair of aortic para-anastomotic pseudoaneurysms has produced durable results.

Key Words: abdominal aortic aneurysms • para-anastomotic aortic pseudoaneurysms • endovascular repair

Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 16, No. 4, 315-322 (2004)
DOI: 10.1177/153100350401600415


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