Paraanastomotic aneurysms of the abdominal aorta: a 15-year experience review

The aim of the study is a retrospective review of clinical presentation and management of paraanastomotic aneurysms of the abdominal aorta (PAAA) surg ically treated in our Department. From January 1984 to December 1998, 2183 aortic prosthetic grafts were impl anted. During the same period, 24 patients were treated for PAAA, 19 false and five true aneurysms. Symptoms were present in 10 patients, Surgical man agement included tube grafting interposition (14), aortobifemoral bypass (2 ), graft removal with extraanatomic bypass (2) and with in situ revasculari zation by arterial homograft (4), Nine patients died during operation or in the early postoperative period, six died during follow-up. Mortality in sy mptomatic patients was 70%, while in asymptomatic group was 14% (P = 0.01). Rupture of false PAAA was very frequent (47% of cases). PAAA are infrequent complications of proximal aortic graft revascularizatio n and tend to be asymptomatic until rupture occurs. The incidence of mortal ity is very different in asymptomatic versus symptomatic group; rupture is particularly frequent in false PAAA, which must soon undergo surgery when d iagnosed. Since PAAA may develop at any time after surgery, their incidence increase in relationship with the length of postoperative interval: theref ore, all patients submitted to abdominal graft revascularization need a lif etime surveillance program, (C) 2000 The International Society for Cardiova scular Surgery. Published by Elsevier Science Ltd. All rights reserved.