Anastomotic pseudoaneurysms after surgical reconstruction: Outcomes after endovascular repair of symptomatic versus asymptomatic patients

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• 作者：Richard Nolz^a ; ^{richard.nolz@meduniwien.ac.at} ; Manfred Gschwendtner^b ; ¹ ; ^{manfred.gschwendtner@elisabethinen.or.at} ; Gregor Jü ; lg^b ; ¹ ; ^{gregor.julg@elisabethinen.or.at} ; Christina Plank^a ; ² ; ^{christina.plank@meduniwien.ac.at} ; Dietrich Beitzke^a ; ² ; ^{dietrich.beitzke@meduniwien.ac.at} ; Harald Teufelsbauer^c ; ³ ; ^{harald.teufelsbauer@meduniwien.ac.at} ; Andreas Wibmer^a ; ² ; ^{andreas.wibmer@meduniwien.ac.at} ; Georg Kretschmer^c ; ² ; ^{georg.kretschmer@meduniwien.ac.at} ; Johannes Lammer^a ; ² ; ^{johannes.lammer@akhwien.at} ; Maria Schoder^a ; ² ; ^{maria.schoder@meduniwien.ac.at}
• 关键词：Endovascular procedures ; Aneurysm ; False ; Aneurysm ; Infected ; Aneurysm ; Ruptured
• 刊名：European Journal of Radiology
• 出版年：2012
• 期刊代码：93_0720048x
• 类别：med
• 出版时间：July, 2012
• 卷：81
• 期：7
• 页码：1589-1594
• 文件大小：544 K

摘要

Purpose

To compare perioperative and follow-up outcomes of symptomatic versus asymptomatic patients following endovascular repair of anastomotic pseudoaneurysms (APAs) of the abdominal aorta and iliac arteries.

Methods

We retrospectively evaluated 17 patients (two women), with a mean age of 66.2 years (range 30-83 years). Endovascular treatment was performed in ten symptomatic, and seven asymptomatic patients electively. Data included technical success, perioperative (within 30 days) mortality and morbidity, as well as stent graft-related complications, reinterventions, and survival in follow-up.

Results

Bifurcated (n = 13), aortomonoiliac (n = 3) endoprosthesis and one aortic cuff were implanted with a primary technical success rate of 100%. The overall in-hospital mortality and morbidity rate was 11.8%and 35.3%. The mean survival was 36.5 (range 0-111) months. There was a clear trend toward a lower overall survival within hospital and at one and three years for symptomatic patients compared to asymptomatic patients. (47.7 (CI: 0-138.8) versus 52.6 (CI: 28.5-76.8) months (p = 0.274)). During follow-up, late stent graft related complications were observed in six patients (35.3%) necessitating eight endovascular reinterventions. Additional three patients with primary fistulas between the APA and the intestine were treated by late surgical revision.

Conclusion

Endovascular therapy of APAs represents a considerable alternative to open surgical repair. Short proximal anchoring zones still pose a risk for endoleaks and unintentional overstenting of side branches with commercially available devices, but this might be overcome by use of fenestrated and branched stent grafts in elective cases.