Uninfected para-anastomotic aneurysms after infrarenal aortic grafting

Paolo Bianchi, Giovanni Nano, Francesco Cusmai, Fabio Ramponi, Silvia Stegher, Daniela Dell'Aglio, Giovanni Malacrida, Domenico G. Tealdi

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: This single-institution retrospective review examines the management of uninfected para-anastomotic aneurysms of the abdominal aorta (PAAA), developed after infrarenal grafting. Materials and Methods: From October 1979 to November 2005, 31 PAAA were observed in our Department. Twenty-six uninfected PAAA of degenerative etiology, including 24 false and 2 true aneurysms, were candidates for intervention and retrospectively included in our database for management and outcome evaluation. Six (23%) patients were treated as emergencies. Surgery included tube graft interposition (n = 12), new reconstruction (n = 8), and graft removal with extra-anatomic bypass (n = 3). Endovascular management (n = 3) consisted of free-flow tube endografts. Results: The mortality rate among the elective and emergency cases was 5% and 66.6%, respectively (p = 0.005). The morbidity rate in elective cases was 57.8%, whereas 75% in emergency cases (p = 0.99). The survival rate during the follow-up was significantly higher for elective cases than for emergency cases. Conclusion: Uninfected PAAA is a late complication of aortic grafting, tends to evolve silently and is difficult to diagnose. The prevalence is underestimated and increases with time since surgery. The mortality rate is higher among patients treated as an emergency than among patients who undergo elective surgery, therefore, elective treatment and aggressive management in the case of pseudoaneurysm are the keys to obtain a good outcome. Endovascular treatment could reduce mortality. Patients who undergo infrarenal aortic grafting require life-long surveillance after surgery.

Original languageEnglish
Pages (from-to)227-238
Number of pages12
JournalYonsei Medical Journal
Volume50
Issue number2
DOIs
Publication statusPublished - 2009

Fingerprint

Aneurysm
Abdominal Aorta
Emergencies
Mortality
Transplants
False Aneurysm
Case Management
Survival Rate
Databases
Morbidity
Therapeutics

Keywords

  • Abdominal aortic grafting
  • Anastomotic aneurysm
  • Endograft
  • Para-anastomotic aneurysm
  • Pseudoaneurysm

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bianchi, P., Nano, G., Cusmai, F., Ramponi, F., Stegher, S., Dell'Aglio, D., ... Tealdi, D. G. (2009). Uninfected para-anastomotic aneurysms after infrarenal aortic grafting. Yonsei Medical Journal, 50(2), 227-238. https://doi.org/10.3349/ymj.2009.50.2.227

Uninfected para-anastomotic aneurysms after infrarenal aortic grafting. / Bianchi, Paolo; Nano, Giovanni; Cusmai, Francesco; Ramponi, Fabio; Stegher, Silvia; Dell'Aglio, Daniela; Malacrida, Giovanni; Tealdi, Domenico G.

In: Yonsei Medical Journal, Vol. 50, No. 2, 2009, p. 227-238.

Research output: Contribution to journalArticle

Bianchi, P, Nano, G, Cusmai, F, Ramponi, F, Stegher, S, Dell'Aglio, D, Malacrida, G & Tealdi, DG 2009, 'Uninfected para-anastomotic aneurysms after infrarenal aortic grafting', Yonsei Medical Journal, vol. 50, no. 2, pp. 227-238. https://doi.org/10.3349/ymj.2009.50.2.227
Bianchi, Paolo ; Nano, Giovanni ; Cusmai, Francesco ; Ramponi, Fabio ; Stegher, Silvia ; Dell'Aglio, Daniela ; Malacrida, Giovanni ; Tealdi, Domenico G. / Uninfected para-anastomotic aneurysms after infrarenal aortic grafting. In: Yonsei Medical Journal. 2009 ; Vol. 50, No. 2. pp. 227-238.
@article{2f79cbc99a974e30a0c188608fa9fcb9,
title = "Uninfected para-anastomotic aneurysms after infrarenal aortic grafting",
abstract = "Purpose: This single-institution retrospective review examines the management of uninfected para-anastomotic aneurysms of the abdominal aorta (PAAA), developed after infrarenal grafting. Materials and Methods: From October 1979 to November 2005, 31 PAAA were observed in our Department. Twenty-six uninfected PAAA of degenerative etiology, including 24 false and 2 true aneurysms, were candidates for intervention and retrospectively included in our database for management and outcome evaluation. Six (23{\%}) patients were treated as emergencies. Surgery included tube graft interposition (n = 12), new reconstruction (n = 8), and graft removal with extra-anatomic bypass (n = 3). Endovascular management (n = 3) consisted of free-flow tube endografts. Results: The mortality rate among the elective and emergency cases was 5{\%} and 66.6{\%}, respectively (p = 0.005). The morbidity rate in elective cases was 57.8{\%}, whereas 75{\%} in emergency cases (p = 0.99). The survival rate during the follow-up was significantly higher for elective cases than for emergency cases. Conclusion: Uninfected PAAA is a late complication of aortic grafting, tends to evolve silently and is difficult to diagnose. The prevalence is underestimated and increases with time since surgery. The mortality rate is higher among patients treated as an emergency than among patients who undergo elective surgery, therefore, elective treatment and aggressive management in the case of pseudoaneurysm are the keys to obtain a good outcome. Endovascular treatment could reduce mortality. Patients who undergo infrarenal aortic grafting require life-long surveillance after surgery.",
keywords = "Abdominal aortic grafting, Anastomotic aneurysm, Endograft, Para-anastomotic aneurysm, Pseudoaneurysm",
author = "Paolo Bianchi and Giovanni Nano and Francesco Cusmai and Fabio Ramponi and Silvia Stegher and Daniela Dell'Aglio and Giovanni Malacrida and Tealdi, {Domenico G.}",
year = "2009",
doi = "10.3349/ymj.2009.50.2.227",
language = "English",
volume = "50",
pages = "227--238",
journal = "Yonsei Medical Journal",
issn = "0513-5796",
publisher = "Yonsei University College of Medicine",
number = "2",

}

TY - JOUR

T1 - Uninfected para-anastomotic aneurysms after infrarenal aortic grafting

AU - Bianchi, Paolo

AU - Nano, Giovanni

AU - Cusmai, Francesco

AU - Ramponi, Fabio

AU - Stegher, Silvia

AU - Dell'Aglio, Daniela

AU - Malacrida, Giovanni

AU - Tealdi, Domenico G.

PY - 2009

Y1 - 2009

N2 - Purpose: This single-institution retrospective review examines the management of uninfected para-anastomotic aneurysms of the abdominal aorta (PAAA), developed after infrarenal grafting. Materials and Methods: From October 1979 to November 2005, 31 PAAA were observed in our Department. Twenty-six uninfected PAAA of degenerative etiology, including 24 false and 2 true aneurysms, were candidates for intervention and retrospectively included in our database for management and outcome evaluation. Six (23%) patients were treated as emergencies. Surgery included tube graft interposition (n = 12), new reconstruction (n = 8), and graft removal with extra-anatomic bypass (n = 3). Endovascular management (n = 3) consisted of free-flow tube endografts. Results: The mortality rate among the elective and emergency cases was 5% and 66.6%, respectively (p = 0.005). The morbidity rate in elective cases was 57.8%, whereas 75% in emergency cases (p = 0.99). The survival rate during the follow-up was significantly higher for elective cases than for emergency cases. Conclusion: Uninfected PAAA is a late complication of aortic grafting, tends to evolve silently and is difficult to diagnose. The prevalence is underestimated and increases with time since surgery. The mortality rate is higher among patients treated as an emergency than among patients who undergo elective surgery, therefore, elective treatment and aggressive management in the case of pseudoaneurysm are the keys to obtain a good outcome. Endovascular treatment could reduce mortality. Patients who undergo infrarenal aortic grafting require life-long surveillance after surgery.

AB - Purpose: This single-institution retrospective review examines the management of uninfected para-anastomotic aneurysms of the abdominal aorta (PAAA), developed after infrarenal grafting. Materials and Methods: From October 1979 to November 2005, 31 PAAA were observed in our Department. Twenty-six uninfected PAAA of degenerative etiology, including 24 false and 2 true aneurysms, were candidates for intervention and retrospectively included in our database for management and outcome evaluation. Six (23%) patients were treated as emergencies. Surgery included tube graft interposition (n = 12), new reconstruction (n = 8), and graft removal with extra-anatomic bypass (n = 3). Endovascular management (n = 3) consisted of free-flow tube endografts. Results: The mortality rate among the elective and emergency cases was 5% and 66.6%, respectively (p = 0.005). The morbidity rate in elective cases was 57.8%, whereas 75% in emergency cases (p = 0.99). The survival rate during the follow-up was significantly higher for elective cases than for emergency cases. Conclusion: Uninfected PAAA is a late complication of aortic grafting, tends to evolve silently and is difficult to diagnose. The prevalence is underestimated and increases with time since surgery. The mortality rate is higher among patients treated as an emergency than among patients who undergo elective surgery, therefore, elective treatment and aggressive management in the case of pseudoaneurysm are the keys to obtain a good outcome. Endovascular treatment could reduce mortality. Patients who undergo infrarenal aortic grafting require life-long surveillance after surgery.

KW - Abdominal aortic grafting

KW - Anastomotic aneurysm

KW - Endograft

KW - Para-anastomotic aneurysm

KW - Pseudoaneurysm

UR - http://www.scopus.com/inward/record.url?scp=66549084325&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=66549084325&partnerID=8YFLogxK

U2 - 10.3349/ymj.2009.50.2.227

DO - 10.3349/ymj.2009.50.2.227

M3 - Article

C2 - 19430556

AN - SCOPUS:66549084325

VL - 50

SP - 227

EP - 238

JO - Yonsei Medical Journal

JF - Yonsei Medical Journal

SN - 0513-5796

IS - 2

ER -