PARA-ANASTOMOTIC ANEURYSMS - INCIDENCE, RISK-FACTORS, TREATMENT AND PROGNOSIS

Background. The purpose of this retrospective study was to analyze the incidence, risk factors, treatment, and prognosis of para-anastomotic aneurysms. Methods. During the period between January, 1980 and Augus t, 1996, 511 patients underwent surgical operations for arterial disea ses with grafts and were followed for more than 30 days (average: 3.5 years). The number of anastomoses was 1445 in all.Until October, 1996, 18 para-anastomotic aneurysms had been detected in 13 patients. By Ka plan-Meier's method, the incidence of para-anastomotic aneurysms at 5, 10, and 15 years was 0.8, 6.2, and 35.8%, respectively. Univariate an alysis indicated that arteriosclerosis obliterans, hypertension, throm boendarterectomy and an anastomosis in the groin were significant risk factors, while stepwised multivariate analysis revealed only hyperten sion as significant. The mean interval from the primary operation to t he diagnosis was 79 months. Ten aneurysms were operated and seven were produced by dehiscence of the anastomotic Line, namely anastomotic an eurysms, and three were juxta-anastomotic aneurysms with intact anasto motic lines. Eight patients underwent resection or exclusion of the an eurysm and reconstruction with a new graft and two patients underwent a replacement of the aneurysmal autovein patch to a Dacron one and ane urysmorrhaphy of the parent aneurysmal artery. Results. No recurrence has been detected. In eight patients who were followed conservatively, two died of rupture and renal failure following acute arterial occlus ion. Conclusions. Since para-anastomotic aneurysms can lead to fatal c omplications, an enlarging or symptomatic aneurysm should be treated p romptly.