Endovascular Solutions to Complications of Open Aortic Repair

Abstract

Open repair of abdominal aortic aneurysms (AAAs) or occlusive disease can be complicated by pseudoaneurysm formation and aneurysmal dilatation of native vessels. Reports of reoperation for these new lesions have a mortality rate of 5–17% electively, and 24–88% if ruptured. These complications are commonly several years after initial repair, and progression of other comorbidities can further complicate a repeat exploration. The authors reviewed 5 cases of late complications of open aortic bypass surgery treated with endovascular stent grafting as an alternative to reexploration in patients with increased risk for morbidity and mortality. Over a 6-year experience, 5 patients underwent endovascular stent grafting to repair paraanastomotic aneurysms. Patient records were reviewed and clinical cardiac risk evaluation was performed. Follow-up clinic notes and computed tomography (CT) scans were evaluated. Between October 1996 and February 2002, 5 patients underwent 6 endovascular procedures to repair paraanastomotic aneurysms. Mean period between interventions was 16.6 ±6.27 years (range 10–25); mean age at endovascular procedure 74.2 ±6.37 years (range 67–84). Cardiac clinical risk index increased in 80% of patients by Goldman Risk Index and in 40% by the Modified Cardiac Risk Index. On completion angiography, there was complete exclusion of the paraanastomotic aneurysms in all cases (100%). Length of postoperative stay was 1.5 ±0.547 days. Mean estimated blood loss at conclusion of endovascular procedure was 577 ±546.504 cc (range, 60 cc–1,500 cc). Mean follow-up was 24.4 ±24.593 months (range, 5–67 months). On repeat imaging, all stent grafts remain patent without rupture or endoleak. Endovascular stent grafting to repair late complications of open AAA repair is a viable alternative to reexploration in patients with significant comorbidities. These procedures can be performed without violating the previous surgical planes of sites. The operations can be performed under local anesthesia and with reduced hospitalizations. In patients with increased risk factors, endovascular stent grafting is a less morbid alternative to open surgical techniques.