Endovascular treatment of para-anastomotic aneurysms after open abdominal aortic surgery

[Endovascular surgery for complications after open surgery of abdominal aorta]

Abdominal aortic aneurysm rupture (AAAR) is a fatal complication and results high mortality rate (40-70%). To date, open surgery remains the method of choice for AAAR in the Russian Federation. Various complications can occur after surgery for RAAA. Typical adverse events are hemorrhagic complications. The authors describe open surgical treatment of RAAA. In postoperative period, hypertensive crisis was followed by distal anastomosis failure and bleeding into the cavity of sutured aneurysmal sac. This complication was successfully eliminated by installation of stent graft.

Mid-Term Results of Fenestrated Endovascular Repair after Prior Open Aortic Reconstruction

This study aims to assess the mid-term results of fenestrated endovascular aneurysm repair (FEVAR) for the treatment of proximal aortic pathology after previous open surgical repair (OSR). All patients with a previous history of OSR of an abdominal aortic aneurysm undergoing a FEVAR procedure between October 2010 and November 2021 were included. The endpoints of the study were technical success, mortality, target vessel patency and reinterventions during follow-up. Thirty-five patients (34 male, mean age 72.9 ± 7 years) were included. The median interval from the primary surgery to the FEVAR procedure was 136 months (range 47–261). The indication for treatment was a para-anastomotic aneurysm in 18 (51%) patients and a true aneurysm due to progression of disease in 17 (49%) patients. Technical success was achieved in 33 (94%) patients. There was one (3%) early death due to postoperative bleeding from a renal artery. Estimated survival at 12, 24 and 36 months was 89.1% ± 6%, 84.4% ± 7.3% and 84.4% ± 7.3%, respectively. There was no aneurysm-related mortality. One (3%) target vessel occluded during follow-up and three (9%) patients underwent late reinterventions. In conclusion, FEVAR is a safe and effective alternative for the endovascular treatment of para-anastomotic aneurysms/pseudoaneurysms after OSR showing high technical success, low mortality and morbidity, and good mid-term outcomes.