Skip to main content
SpringerLink
Log in

Endovascular Repair of Para-Anastomotic Aortoiliac Aneurysms

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

The purpose of this study is to evaluate the use of endovascular stent grafts in the treatment of para-anastomotic aneurysms (PAAs) as an alternative to high-risk open surgical repair. We identified all patients with previous open aortic aneurysm repair who underwent infrarenal endovascular aneurysm repair (EVAR) at our institution from June 1998 to April 2007. Patient demographics, previous surgery, and operative complications were recorded. One hundred forty-eight patients underwent EVAR during the study period and 11 patients had previous aortic surgery. Of these 11 redo patients, the mean age was 62 years at initial surgery and 71 years at EVAR. All patients were male. Initial open repair was for rupture in five (45%) patients. The average time between initial and subsequent reintervention was 9 years. All patients were ASA Grade III or IV. Fifty-five percent of the PAAs involved the iliac arteries, 36% the abdominal aorta, and 9% were aortoiliac. Ten patients had endovascular stent-grafts inserted electively, and one patient presented with a contained leak. Aorto-uni-iliac stent-grafts were deployed in seven patients, and bifurcated stent-grafts in four patients. A 100% successful deployment rate was achieved. Perioperative mortality was not seen and one patient needed surgical reintervention to correct an endoleak. Endovascular repair of PAAs is safe and feasible. It is a suitable alternative and has probably now become the treatment of choice in the management of PAAs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mii S, Mori A, Sakata H, Kawazoe N (1998) Para-anastomotic aneurysms: incidence, risk factors, treatment and prognosis. J Cardiovasc Surg (Torino) 39:259–266

    CAS  Google Scholar 

  2. Biancari F, Ylonen K, Anttila V et al (2002) Durability of open repair of infrarenal abdominal aortic aneurysm: a 15-year follow-up study. J Vasc Surg 35:87–93

    PubMed  Google Scholar 

  3. Allen RC, Schneider J, Longenecker L, Smith RBIII, Lumsden AB (1993) Paraanastomotic aneurysms of the abdominal aorta. J Vasc Surg 18:424–431 (discussion 431–432)

    Article  CAS  PubMed  Google Scholar 

  4. Curl GR, Faggioli GL, Stella A, D’Addato M, Ricotta JJ (1992) Aneurysmal change at or above the proximal anastomosis after infrarenal aortic grafting. J Vasc Surg 16:855–859 (discussion 859–860)

    Article  CAS  PubMed  Google Scholar 

  5. Yuan JG, Marin ML, Veith FJ et al (1997) Endovascular grafts for noninfected aortoiliac anastomotic aneurysms. J Vasc Surg 26:210–221

    Article  CAS  PubMed  Google Scholar 

  6. Baker DM, Hinchliffe RJ, Yusuf SW, Whitaker SC, Hopkinson BR (2003) True juxta-anastomotic aneurysms in the residual infra-renal abdominal aorta. Eur J Vasc Endovasc Surg 25:412–415

    Article  CAS  PubMed  Google Scholar 

  7. Slade JG, Gerein AN, Miyagishima RT (1987) Late rupture of prosthetic aortic grafts. Am J Surg 153:453–458

    Article  Google Scholar 

  8. Levi N, Sonksen JR, Iversen P, Helgstrand U (1999) Rupture of an iliac artery pseudoaneurysm into a ureter. Eur J Vasc Endovasc Surg 17:264–265

    Article  CAS  PubMed  Google Scholar 

  9. van Herwaarden JA, Waasdorp EJ, Bendermacher BL, van den Berg JC, Teijink JA, Moll FL (2004) Endovascular repair of paraanastomotic aneurysms after previous open aortic prosthetic reconstruction. Ann Vasc Surg 18:280–286

    Article  PubMed  Google Scholar 

  10. EVAR trial participants (2005) Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 365:2179–2186

    Article  Google Scholar 

  11. Prinssen M, Verhoeven ELG, Buth J (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351:1607–1618

    Google Scholar 

  12. Locati P, Socrate AM, Costantini E (2000) Paraanastomotic aneurysms of the abdominal aorta: a 15-year experience review. Cardiovasc Surg 8:274–279

    Article  CAS  PubMed  Google Scholar 

  13. Edwards JM, Teefey SA, Zierler RE, Kohler TR (1992) Intraabdominal paraanastomotic aneurysms after aortic bypass grafting. J Vasc Surg 15:344–350 (discussion 351–353)

    Article  CAS  PubMed  Google Scholar 

  14. Abou-Zamzam AM Jr, Ballard JL (2001) Management of sterile para-anastomotic aneurysms of the aorta. Semin Vasc Surg 14:282–291

    Article  PubMed  Google Scholar 

  15. Dennis JW, Littooy FN, Greisler HP, Baker WH (1986) Anastomotic false aneurysms: a continuing late complication of vascular reconstructive procedures. Arch Surg 121:314–317

    CAS  PubMed  Google Scholar 

  16. Mulder EJ, van Bockel JH, Maas J, van den Akker PJ, Hermans J (1998) Morbidity and mortality of reconstructive surgery of noninfected false aneurysms detected long after aortic prosthetic reconstruction. Arch Surg 133:45–49

    Article  CAS  PubMed  Google Scholar 

  17. Matsumura JS, Pearce WH, Cabellon A, McCarthy WJIII, Yao JS (1999) Reoperative aortic surgery. Cardiovasc Surg 7:614–621

    Article  CAS  PubMed  Google Scholar 

  18. Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491–499

    Article  CAS  PubMed  Google Scholar 

  19. Lovegrove RE, Javid M, Magee TR, Galland RB (2008) A meta-analysis of 21178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg 95:677–684

    Article  CAS  PubMed  Google Scholar 

  20. Schermerhorn ML, O’Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358:464–474

    Article  CAS  PubMed  Google Scholar 

  21. Lagana D, Carrafiello G, Mangini M et al (2007) Endovascular treatment of anastomotic pseudoaneurysms after aorto-iliac surgical reconstruction. Cardiovasc Intervent Radiol 30:1185–1191

    Article  PubMed  Google Scholar 

  22. Morrissey NJ, Yano OJ, Soundararajan K et al (2001) Endovascular repair of para-anastomotic aneurysms of the aorta and iliac arteries: preferred treatment for a complex problem. J Vasc Surg 33:503–512

    Article  Google Scholar 

  23. Di Tommaso L, Monaco M, Priscione F, Sarno G, Iannelli G (2007) Endovascular stent grafts as a safe secondary option for paraanastomotic abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 33:91–93

    Article  PubMed  Google Scholar 

  24. El Sakka K, Halawa M, Kotze C, Francis I, Doyle T, Yusuf W (2008) Complications of open abdominal aortic surgery: the endovascular solution. Interact Cardiovasc Thorac Surg 7:121–125

    Article  PubMed  Google Scholar 

  25. Sachdev U, Baril DT, Morrissey NJ et al (2007) Endovascular repair of para-anastomotic aortic aneurysms. J Vasc Surg 46:636–641

    Article  PubMed  Google Scholar 

  26. Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Caronno R, Castelli P (2007) Endovascular treatment for para-anastomotic abdominal aortic and iliac aneurysms following aortic surgery. J Cardiovasc Surg (Torino) 48:711–717

    CAS  Google Scholar 

  27. Gawenda M, Zaehringer M, Brunkwall J (2003) Open versus endovascular repair of para-anastomotic aneurysms in patients who were morphological candidates for endovascular treatment. J Endovasc Ther 10:745–751

    Article  PubMed  Google Scholar 

  28. Maldonado TS, Rockman CB, Riles E et al (2004) Ischemic complications after endovascular abdominal aortic aneurysm repair. J Vasc Surg 40:703–710

    Article  PubMed  Google Scholar 

  29. Erzurum VZ, Sampram ESK, Sarac TP et al (2004) Initial management and outcome of aortic endograft limb occlusion. J Vasc Surg 40:419–423

    Article  PubMed  Google Scholar 

  30. Verhoeven ELG, Muhs BE, Zeebregts CJAM et al (2007) Fenestrated and branched stent-grafting after previous surgery provides a good alternative to open redo surgery. Eur J Vasc Endovasc Surg 33:84–90

    Article  CAS  PubMed  Google Scholar 

  31. Ziegler P, Perdikides TP, Avgerinos ED, Umscheid T, Stelter WJ (2007) Fenestrated and branched grafts for para-anastomotic aortic aneurysm repair. J Endovasc Ther 14:513–519

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Vascular Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland

    Julian S. Tsang, Peter A. Naughton, Tim T. Wang, Daragh S. Moneley, Cathal J. Kelly & Austin L. Leahy

  2. Department of Interventional Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland

    Aoife N. Keeling & Michael J. Lee

Authors
  1. Julian S. Tsang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter A. Naughton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tim T. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aoife N. Keeling
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daragh S. Moneley
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael J. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cathal J. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Austin L. Leahy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julian S. Tsang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tsang, J.S., Naughton, P.A., Wang, T.T. et al. Endovascular Repair of Para-Anastomotic Aortoiliac Aneurysms. Cardiovasc Intervent Radiol 32, 1165–1170 (2009). https://doi.org/10.1007/s00270-009-9653-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-009-9653-0

Keywords

Search

Navigation