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Review
. 2007;34(2):148-53.

Endovascular repair of paraanastomotic aneurysms after aortic reconstruction

James H Mitchell  1 , Kathryn G Dougherty, Neil E Strickman, Ali Mortazavi, Zvonimir Krajcer
Affiliations
Review

Endovascular repair of paraanastomotic aneurysms after aortic reconstruction

James H Mitchell et al. Tex Heart Inst J. 2007.

Abstract

We designed this retrospective study to evaluate the effectiveness of percutaneous approaches for repair of paraanastomotic aneurysms that develop after surgical aortic reconstruction. The catheterization records of patients who had undergone percutaneous repair of para-anastomotic aneurysms from January 2001 through December 2005 were reviewed, and data regarding preoperative aneurysm size, risk factors, intraoperative techniques, morbidity, and death were recorded. Eight patients had undergone exclusion of a total of 10 paraanastomotic aneurysms. The average age of the prosthetic graft at diagnosis was 11.7 years. Four of the patients were symptomatic; none of these had a ruptured aneurysm. All patients received commercially available devices. Technical success was achieved in all patients. Conscious sedation alone was administered to 7 patients. There were no in-hospital deaths, and morbidity was minimal. We conclude that endovascular exclusion of paraanastomotic aneurysms after aortic reconstruction is a viable alternative to open surgical repair and greatly reduces the risk of morbidity and death.

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Figures

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Fig. 1 Patient 5. Initial computed tomographic angiogram reveals distal occlusion of the native aorta and a patent unilateral aortic-to-right-iliac bypass graft. At the proximal anastomosis, there is residual aneurysmal dilation of 4 cm (arrow). Thrombus is present in the left bypass graft, which is not visible (curved arrow).
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Fig. 2 Patient 5. Initial angiogram shows para-anastomotic aneurysmal dilation, with occlusion of the left aortoiliac bypass graft (arrow).
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Fig. 3 Patient 5. Angiogram reveals exclusion of the para-anas-tomotic aneurysm after deployment of 4 Zenith (Cook) aortic extension grafts. An AneuRx cuff (Medtronic) was placed to seal a residual type III endoleak (arrow).
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Fig. 4 Patient 5. Computed tomographic angiogram at 3-month follow-up shows a patent femorofemoral bypass graft (arrow) and no recurrence of aneurysm or endoleak.
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