Endovascular repair of para-anastomotic aneurysms of the aorta and iliac arteries: Preferred treatment for a complex problem

Purpose: Standard surgical repair of para-anastamotic aneurysms (PAAs) of t he abdominal and thoracic aorta and the iliac arteries has been associated with high morbidity and mortality rates. We reviewed our continuing experie nce with endovascular repair of these lesions to determine whether this app roach is favorable and durable. Methods: All patients with PAAs of the aorta or iliac arteries who underwen t endovascular treatment of their lesions between August 1993 and July 1999 were prospectively followed up, and data on age, previous aortic pathology and surgery, size of PAA, time to diagnosis, and symptoms at presentation were recorded. Preoperative, intraoperative, and postoperative imaging stud ies were analyzed. All patients had endovascular stent-grafts placed under digital fluoroscopic guidance in the operating room. Data on intraoperative and postoperative complications, mortality, and endoleaks were reviewed. Results: From August 1993 to July 1999, 28 patients (20 men, 8 women) had 3 5 PAAs of the aorta or iliac arteries. There were 5 thoracic aortic, 12 abd ominal aortic, and 18 iliac artery PAAs. Three patients had a contained rup ture of their FAA. All patients who had originally undergone reconstruction for occlusive disease had lesions consistent with false aneurysms, whereas 73% of the aortic or iliac PAAs in patients originally treated for aneurys m disease appeared to be true aneurysms. Thirty-four of 35 PAAs were succes sfully excluded with stent-grafts (97%). There was one death at 30 days (3. 6%) in a patient who was successfully treated endovascularly for a containe d rupture of a thoracic PAA. There were four major postoperative complicati ons (14.2%) in the 28 patients who were treated. One patient had continued perfusion of a thoracic aortic PAA (type I endoleak). The in-hospital lengt h of stay after endovascular repair of PAA was 4 days (range, 1-18 days). T he mean follow-up period was 21 months (range, 1-68 months). Conclusion: Endovascular repair of aortic and iliac artery PAAs is technica lly feasible and provides a high rate of lesion exclusion. Morbidity and mo rtality rates appear lower than those reported for open surgical repair. Th ese patients can typically be discharged by the second postoperative day. E ndovascular therapy for stable ruptured PAAs can be successfully performed and should be considered as an option only when appropriate devices and exp ertise are available. For uncomplicated PAAs of the aorta and iliac arterie s, endovascular therapy may be more favorable than surgical repair.