MORBIDITY AND MORTALITY OF RECONSTRUCTIVE SURGERY OF NONINFECTED FALSE ANEURYSMS DETECTED LONG AFTER AORTIC PROSTHETIC RECONSTRUCTION

Objective: To determine the morbidity and mortality of surgical treatm ent of false (anastomotic) aneurysms, we analyzed the results of 158 c onsecutive surgical procedures for repair of false aneurysms that were detected as a result of a surveillance program after aortic reconstru ction with a prosthesis. Design: Retrospective analysis of patient dat a from a vascular registry that included information on the longterm f ollow-up of our patients. Setting: A university hospital (tertiary ref erral center) in the Netherlands that has been performing vascular rec onstructive surgery since 1958. Patients: We performed 158 surgical pr ocedures on 135 patients with 220 noninfected false aneurysms. Using a yearly surveillance program, the false aneurysms were detected at a m ean interval of 8 years after the initial reconstruction. Most patient s (60%) were asymptomatic. The operation was performed as an emergency in 25 instances (16%). Results: The mortality rate of patients receiv ing nonsurgical treatment was very high (61%) owing to documented rupt ure (11 of 18 patients). The intraoperative death rate was 7.6% per pr ocedure. This was higher for emergency (24%) than for elective procedu res (4.5%). Conclusions: Conservative follow-up carries a very high mo rtality rate, as does emergency surgery for a false aneurysm. However, the intraoperative mortality rate of elective reconstruction of a fal se aneurysm can be in the same range as that of elective primary aorti c reconstruction. Therefore, we advocate a surveillance program, inclu ding yearly ultrasound studies, after prosthetic aortic reconstruction for the timely detection and elective repair of all false aneurysms.