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The Journal of Cardiovascular Surgery 2020 April;61(2):159-70

DOI: 10.23736/S0021-9509.18.10145-5


lingua: Inglese

Endovascular treatment of para-anastomotic aneurysms after open abdominal aortic surgery

Konstantinos SPANOS 1 , Tilo KÖLBEL 1, George KOUVELOS 2, Nikolaos TSILIMPARIS 1, Sebastian E. DEBUS 1, Athanasios D. GIANNOUKAS 2

1 Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany; 2 Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece

INTRODUCTION: The repair of long-term complications of open abdominal aortic repair such as para-anastomotic aneurysm (PAA) and pseudoaneurysm (PSA) is very challenging. The aim of this study was to assess the outcomes of endovascular repair of PAA/PSA after previous open aortic surgery for aneurismal or occlusive disease.
EVIDENCE ACQUISITION: A systematic review was undertaken; a search was performed (PRISMA) in MEDLINE, CENTRAL, Cochrane databases and key references of all studies of endovascular treatment of PAA/PSA after open aortic surgery.
EVIDENCE SYNTHESIS: Eighteen studies included totally 433 patients (86.3% males) with mean age of 71±2.5 years were identified. Most of the patients were asymptomatic (76%) and diagnosed with PAA (60.5%), while 81.6% had history of open aortic reconstruction for aneurismal disease. The mean diameter of para-anastomotic aneurysms was 59.7 mm (from 23 mm to 110 mm) and the mean duration until their diagnosis was 10±2 years. Standard bifurcated (23.7%), fenestrated (23.4%) and aorto-uni-iliac stent-grafts (16.3%) were mostly used. The technical success rate was 97.8% (391/400) with 1.4% (6/433) 30 day-mortality rate and mean hospital stay of 6±3 days. The mean 1- and 2- year survival rate was 87.8% and 78.8%, respectively. The follow-up ranged from 9 to 43 months, with presenting complications such as endoleak type I (24/378; 6.3%), type II (15/354; 4.3%), type III (3/378;0.8%), migration (4/378; 1%) and limb occlusion (5/310;1.6%). Additionally, 5.7% (19/332) of the patients underwent open conversion, while the total re-intervention rate was 11.4% (39/340; time of reintervention ranged from 7 to 30 months). In cases in which a stent was used for splanchnic vessels (renal artery: 188, superior mesenteric artery: 98, celiac artery: 64), the primary patency rate was 97.4% (341/350).
CONCLUSIONS: Endovascular treatment of PAAs and PSAs after previous open aortic surgery is a feasible and efficient option with high technical success rate, low 30-day mortality and good mid-term outcomes.

KEY WORDS: Aortic aneurysm, abdominal; Aneurysm, false; Endovascular procedures

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