LATE COMPLICATIONS OF ABDOMINAL AORTIC PR OSTHETIC RECONSTRUCTION - MANAGEMENT OF FALSE ANASTOMOTIC ANEURYSMS AND AORTOENTERIC FISTULA

Pseudoaneurysms of the abdominal aorta (PAAA) are late complications o f aortic reconstruction that occur with an incidence varying from 4.8 to 6.3% associated with an operative mortality of 21 to 35%. Between 1 987 and 1994, 16 patients with a PAAA (14 men and two women, with a me an age of 69.5 years, ranging from 55 to 82 years) were treated in our unit. An anastomotic rupture with a pseudoaneurysm diameter varying f rom 50 to 75 mm was present in five cases (group 1). The eleven other cases were aortoenteric fistula, isolated in six cases (group 2) and a ssociated with local and/or general sepsis signs in five cases (group 3). The mean interval from the time of the primary aortic graft, which was performed as treatment for aortic aneurysm in six cases and for a ortoiliac occlusive disease in 10 cases, and the diagnosis of the PAAA , was 11.3 years. An in situ replacement of the aortic graft with an i nterposi tion of the greater omentum was performed in each patient of groups 1 and 2, associated with an enteric restauration in the latter. Group 3 patients were treated by removal of the infected graft with c losure of the aortic stump and extra-anatomic bypass. During the post- operative period, five deaths (31%) and one limb amputation (6%) occur red, i.e. one death in group 1 (20%), one in group 2 (17%) and three i n group 3 (60%) associated with a limb amputation (20%). Our study sho ws that an in situ graft replacement may be recommended in case of duo denal disruption without septical signs, with comparable results to th ose obtained for patients presenting with an isolated pseudoaneurysm. On the contrary, patients presenting with local and/or general sepsis signs represent a subgroup with a high surgical risk in which graft re moval and extraanatomic bypass is responsible for a high rate of morta lity and morbidity. In situ implantation of a cryogenically-preserved allograft may represent an interesting alternative for such patients ( J Mal Vase 1995; 20 : pages 172-176).