OBJECTIVE: To determine the morbidity and mortality of surgical treatment of false (anastomotic) aneurysms, we analyzed the results of 158 consecutive surgical procedures for repair of false aneurysms that were detected as a result of a surveillance program after aortic reconstruction with a prosthesis. DESIGN: Retrospective analysis of patient data from a vascular registry that included information on the long-term follow-up of our patients. SETTING: A university hospital (tertiary referral center) in the Netherlands that has been performing vascular reconstructive surgery since 1958. PATIENTS: We performed 158 surgical procedures on 135 patients with 220 noninfected false aneurysms. Using a yearly surveillance program, the false aneurysms were detected at a mean interval of 8 years after the initial reconstruction. Most patients (60%) were asymptomatic. The operation was performed as an emergency in 25 instances (16%). RESULTS: The mortality rate of patients receiving nonsurgical treatment was very high (61%) owing to documented rupture (11 of 18 patients). The intraoperative death rate was 7.6% per procedure. This was higher for emergency (24%) than for elective procedures (4.5%). CONCLUSIONS: Conservative follow-up carries a very high mortality rate, as does emergency surgery for a false aneurysm. However, the intraoperative mortality rate of elective reconstruction of a false aneurysm can be in the same range as that of elective primary aortic reconstruction. Therefore, we advocate a surveillance program, including yearly ultrasound studies, after prosthetic aortic reconstruction for the timely detection and elective repair of all false aneurysms.
OBJECTIVE: To determine the morbidity and mortality of surgical treatment of false (anastomotic) aneurysms, we analyzed the results of 158 consecutive surgical procedures for repair of false aneurysms that were detected as a result of a surveillance program after aortic reconstruction with a prosthesis. DESIGN: Retrospective analysis of patient data from a vascular registry that included information on the long-term follow-up of our patients. SETTING: A university hospital (tertiary referral center) in the Netherlands that has been performing vascular reconstructive surgery since 1958. PATIENTS: We performed 158 surgical procedures on 135 patients with 220 noninfected false aneurysms. Using a yearly surveillance program, the false aneurysms were detected at a mean interval of 8 years after the initial reconstruction. Most patients (60%) were asymptomatic. The operation was performed as an emergency in 25 instances (16%). RESULTS: The mortality rate of patients receiving nonsurgical treatment was very high (61%) owing to documented rupture (11 of 18 patients). The intraoperative death rate was 7.6% per procedure. This was higher for emergency (24%) than for elective procedures (4.5%). CONCLUSIONS: Conservative follow-up carries a very high mortality rate, as does emergency surgery for a false aneurysm. However, the intraoperative mortality rate of elective reconstruction of a false aneurysm can be in the same range as that of elective primary aortic reconstruction. Therefore, we advocate a surveillance program, including yearly ultrasound studies, after prosthetic aortic reconstruction for the timely detection and elective repair of all false aneurysms.
Authors: Paolo Bianchi; Giovanni Nano; Francesco Cusmai; Fabio Ramponi; Silvia Stegher; Daniela Dell'Aglio; Giovanni Malacrida; Domenico G Tealdi Journal: Yonsei Med J Date: 2009-04-30 Impact factor: 2.759