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The Journal of Cardiovascular Surgery 1998 June;39(3):259-66

language: English

Para-anastomotic aneu­rysms: incidence, ­risk fac­tors, treat­ment ­and prog­no­sis

Mii Sh., Mori A., Sak­a­ta H., Kaw­a­zoe N.*

From ­the Department of Surgery *Department of Cardiology Nippon Steel Corporation Works Yawata Hospital 1-1-1 Harunomachi, Yahatahigashi-ku Kitakyushu-­city 805, Japan


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Background. The pur­pose of ­this ret­ro­spec­tive ­study ­was to ana­lyze ­the inci­dence, ­risk fac­tors, treat­ment, ­and prog­no­sis of par­a­-anastomotic aneu­rysms.
Methods. During ­the peri­od ­between January, 1980 ­and August, 1996, 511 ­patients under­went sur­gi­cal oper­a­tions ­for arte­ri­al dis­eas­es ­with ­grafts ­and ­were fol­lowed ­for ­more ­than 30 ­days (aver­age: 3.5 ­years). The num­ber of anas­to­mos­es ­was 1445 in ­all. Until October, 1996, 18 par­a­-anastomotic aneu­rysms ­had ­been detect­ed in 13 ­patients. By Kaplan-Meier’s meth­od, ­the inci­dence of par­a­-anastomotic aneu­rysms at 5, 10, ­and 15 ­years ­was 0.8, 6.2, ­and 35.8%, respec­tive­ly. Univariate anal­y­sis indi­cat­ed ­that arte­rio­scle­ro­sis oblit­e­rans, hyper­ten­sion, throm­boen­dar­te­rec­to­my ­and an anas­tom­o­sis in ­the ­groin ­were sig­nif­i­cant ­risk fac­tors, ­while step­wised mul­ti­var­i­ate anal­y­sis ­revealed ­only hyper­ten­sion as sig­nif­i­cant. The ­mean inter­val ­from ­the pri­mary oper­a­tion to ­the diag­no­sis ­was 79 ­months. Ten aneu­rysms ­were oper­at­ed ­and sev­en ­were pro­duced by dehis­cence of ­the anas­to­mot­ic ­line, name­ly anas­to­mot­ic aneu­rysms, ­and ­three ­were jux­ta­anas­to­mot­ic aneu­rysms ­with ­intact anas­to­mot­ic ­lines. Eight ­patients under­went resec­tion or exclu­sion of ­the aneu­rysm ­and recon­struc­tion ­with a ­new ­graft ­and ­two ­patients under­went a replace­ment of ­the aneu­rys­mal auto­ve­in ­patch to a Dacron ­one ­and aneu­rys­mor­rha­phy of ­the par­ent aneu­rys­mal ­artery.
Results. No recur­rence ­has ­been detect­ed. In ­eight ­patients ­who ­were fol­lowed con­ser­va­tive­ly, ­two ­died of rup­ture ­and ­renal fail­ure fol­low­ing ­acute arte­ri­al occlu­sion.
Conclusions. Since par­a­-anastomotic aneu­rysms ­can ­lead to ­fatal com­pli­ca­tions, an enlarg­ing or symp­to­mat­ic aneu­rysm ­should be treat­ed prompt­ly.

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