Endograft Repair of Aortic Anastomotic Aneurysms
Charles S Kiell, Steven D Harlan
Frye Regional Medical Center, Hickory, NC
Endograft Repair of Aortic Anastomotic Aneurysm
Background: Anastomotic aneurysms (AA) are a known complication of aortic reconstruction. Although rupture risk is not clearly defined, open surgical repair does carry considerable risk. Patients typically present many years later, possibly placing them in a more medically-compromised conditions than existed at the time of original repair. Endovascular repair of AA has been described, but management of contiguous patent vessels, maintenance of antegrade flow in critical vessels, and access issues can add additional complexity.
Methods: We describe four cases of endovascular AArepair (3 male, 1 female). All original reconstructions were for occlusive disease. An average of 2 AA/patient was present. All grafts were Dacron with proximal configuration being either end-to-side (3) or end-to-end (1). Mean patient age was 75, exhibiting an average of 15 years from original procedure to AA diagnosis. No patient exhibited signs of systemic infection. All patients were studied by computerized tomographic angiography (CTA) followed by catheter angiography and any contiguous patent vessel, i.e. distal aorta or iliac, communicating directly with the AA was treated by percutaneous placement of coils and/or bilobed-occlusion plugs. Definitive AA repair was later accomplished using conventional bifurcated endografts and/or extension cuffs. Selective hypogastic revascularization and alternative delivery access sites were also employed when physiologically and anatomically necessary.
Results: All cases were successfully carried out with widely-patent axial flow maintained and without need for extra-anatomical reconstruction. No peri-procedural endoleak or complications were seen. Post-operative hospital stay averaged 1.3 days. At follow-up period ranging from 4-43 months, all patients are alive, asymptomatic and with excluded AA demonstrated by CTA. No infectious issues have developed.
Conclusion: Appropriate imaging and treatment planning allowed for successful endovascular repair of 4 proximal anastomotic aneurysms. Treatment adjuncts such as coils, plugs, alternative access sites and selective hypogastric reconstruction allowed for uneventful repair with conventional endografts and cuffs. Durable repair without morbidity and rapid recovery was seen in all cases. Endovascular AA repair offers an attractive alternative to open repair, especially for the older, more fragile patient.
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