Surgical and endovascular treatment of abdominal aortic pseudoaneurysms

Aim. Personal experience with surgical and endovascular repair of aortic and iliac anastomotic pseudoaneurysms is described. Methods. Between January 1991 and December 2002, 28 aortic or iliac anastomotic pseudoaneurysms were treated in 27 patients; 18 patients (66.7%) underwent standard surgical repair of an anastomotic pseudoaneurysm, one of them due to an aortoenteric fistula. A further 10 anastomotic pseudoaneurysms (6 aortic, 4 iliac) in 9 patients (33.3%) were treated by endovascular graft exclusion. Results. The early total technical success rate was 89.3%; 88.9 % in the open repair group and 90% in the endovascular repair group with a postoperative mortality rate of 11.1% and 10%, respectively. In the surgical repair group, 4 patients were lost to follow-up, and there were 2 deaths unrelated to the procedure. In the remaining 10 patients, there was only 1 recurrent aortic distal anastomotic pseudoaneurysm (mean follow-up: 6.6 years). In the endovascular repair group, there were 2 open repair conversions and 2 unrelated deaths. In the remaining 5 patients the pseudoaneurysms were successfully excluded with stent-grafts at a mean follow-up of 3.4 years. Conclusion. The treatment of aortoiliac anastomotic pseudoaneurysms is advocated only in cases of expanding aneurysms or those with a diameter ≥5 cm, given the generally high operative morbidity and mortality. Endovascular repair which is technically feasible and provides a high rate of lesion exclusion, appears to be a good alternative to standard surgical repair in selected cases.