FATE OF THE EXCLUDED ABDOMINAL AORTIC-ANEURYSM SAC - LONG-TERM FOLLOW-UP OF 831 PATIENTS

Purpose: Nonresective treatment of the infrarenal abdominal aortic ane urysm by proximal and distal ligation of the aneurysm sac (exclusion) combined with aortic bypass has, been previously reported. A 10-year e xperience with 831 patients undergoing this procedure was reviewed. Me thods: from 1984 to 1994, 831 (761 elective, 70 urgent) of 1103 patien ts being treated for abdominal aortic aneurysm underwent repair with t he retroperitoneal exclusion technique. Perioperative morbidity and mo rtality, estimated blood loss, transfusion requirements, natural histo ry of the excluded aneurysm sac, and long-term survival were all asses sed. Results: The operative mortality rate for patients undergoing exc lusion and bypass was 3.4%. The incidence of nonfatal perioperative co mplications was 5.2%. Colon ischemia requiring resection occurred in 2 (0.2%) of the 831 patients. Estimated blood loss was 638 +/- 557 cc ( 50 to 330 cc). On follow-up 17 (2%) patients were found to have patent aneurysm sacs as detected by duplex examination. fourteen patients re quired surgical intervention. No cases of graft infection or aortoente ric fistula have been noted. Conclusion: Retroperitoneal exclusion and bypass is a viable alternative to traditional open endoaneurysmorraph y in surgery for abdominal aortic aneurysm. Most excluded aneurysm sac s have thrombosis without any long- or short-term complications; howev er, in a small number of patients delayed rupture of patent aneurysm o ccurs, thus emphasizing the need for diligent follow-up and appropriat e intervention.