GRAFT-RELATED COMPLICATIONS AFTER ABDOMINAL AORTIC-ANEURYSM REPAIR - REASSURANCE FROM A 36-YEAR POPULATION-BASED EXPERIENCE

Purpose: Graft-related complications must be factored into the long-te rm morbidity and mortality rates of abdominal aortic aneurysm (AAA) re pair. However, the true incidence may be underestimated because some p atients do not return to the original surgical center when a problem a rises. Methods: To minimize referral bias and loss to follow-up, we st udied all patients who underwent AAA repair between 1957 and 1990 in a geographically defined community where all AAA operations were perfor med and followed by a single surgical practice. All patients who remai ned alive were asked to have their aortic grafts imaged. Results: Amon g 307 patients who underwent AAA repair, 29 patients (9.4%) had a graf t-related complication. At a mean follow-up of 5.8 years (range, <30 d ays to 36 years), the most common complication was anastomotic pseudoa neurysm (3.0%), followed by graft thrombosis (2.0%), graft-enteric ero sion/fistula (1.6%), graft infection (1.3%), anastomotic hemorrhage (1 .3%), colon ischemia (0.7%), and atheroembolism (0.3%). Complications were recognized within 30 days after surgery in eight patients (2.6%) and at late follow-up in 21 patients (6.8%). These complications were observed at a median follow-up of 6.1 years for anastomotic pseudoaneu rysm, 4.3 years for graft enteric erosion, and 0.15 years for graft in fection. Kaplan-Meier 5- and 10-year survival free estimates were 98% and 96% for anastomotic pseudoaneurysm, 98% and 95% for combined graft -enteric erosion/infection, and 98% and 97% for graft thrombosis. Conc lusions: This 36-year population-based study confirms that the vast ma jority of patients who undergo standard surgical repair of an abdomina l aortic aneurysm remain fi ee of any significant graft-related compli cation during their remaining lifetime.