Late angiographic follow-up review of surgically treated aneurysms

Object. This study was undertaken to evaluate the long-term angiographic ou tcome of surgically treated aneurysms, which is unknown. Specifically, the incidence of recurrent aneurysms, the fate of residual necks, and the de no vo formation of aneurysms were evaluated. Methods. One hundred two patients (80 females and 22 males; mean age 49 yea rs; range 12-78 years) harboring a total of 167 aneurysms underwent late fo llow-up angiography; 160 aneurysms were surgically treated. Late angiograph ic follow-up review was obtained at a mean of 4.4 +/- 1.6 years postsurgery (range 2.6-9.7 years). Late follow-up angiography revealed two recurrent a neurysms (1.5%) of 135 clipped aneurysms without residua. Of 12 aneurysms w ith known residua, there were eight "dog-ear" residua, of which two (25%) e nlarged. One hemorrhage was noted, yielding a hemorrhage risk of 1.9% per y ear. A second subgroup with broad-based residua revealed dramatic regrowth in three of four cases. Eight de novo aneurysms were found in six patients, for an annual risk of 1.8% per year. A history of multiple aneurysms was a ssociated with de novo aneurysm formation (p = 0.049, chi-square analysis). Conclusions. This study confirms the long-term efficacy of aneurysm clip li gation. In addition, the authors found there is a small but significant ris k of de novo aneurysm formation, particularly in patients with multiple ane urysms. Most residual aneurysm rests appear to remain stable, although a su bset may enlarge or rupture. These findings support the rationale for late angiographic follow-up review in patients with aneurysms.