Erin H. Murphy, Benjamin J. Herdrich, Benjamin M. Jackson, Grace J. Wang, Jeffrey P. Carpenter, Ronald M. Fairman, Edward Y. Woo
Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
OBJECTIVES: Open surgical re-interventions for aortic disease can be technically difficult and associated with increased morbidity and mortality. We report our experience with endovascular interventions as alternative treatments for complications following open aortic surgery.
METHODS: A retrospective database was used to identify patients who underwent endovascular interventions to treat complications of open aortic surgery. Records were reviewed for demographics, presentations, details of interventions, and operative outcomes.
RESULTS: Between 2005 and 2011, 20 patients underwent endovascular interventions to treat complications of open aortic surgery. Patients had a male predominance (17) and a mean age of 69.1±11.4 (41-85) years. Initial surgeries included open AAA repair (7), open arch surgery (3), aorto-bifemoral bypass (7), aorto-visceral bypass (2) and primary repair of aorto-duodenal fistula (1). Indications for re-interventions included anastomotic pseudoaneurysm (PSA)(12: proximal-8, distal-4), graft occlusion (5) and aorto-enteric fistula (3). Mean time to re-interventions was 85.3+/-108.1 (0.6-372) months and consisted of EVAR (12) with splenic (1) or renal (1) embolization, TEVAR (3), or iliac stents (5). Over half of re-interventions were urgent or emergent (11). Technical success was 100%. EBL was 399.0+/-372.9. There was 1 peri-operative death from hemorrhagic gallstone pancreatitis however, PSA was excluded. There was 1 morbidity of a peri-operative stroke after TEVAR for an ascending aortic PSA (5.0%). Mean hospital and ICU stays were 6.0±3.7 and 1.1±1.8 days, respectively. Follow-up was 17.1±23.1 (1-72) months. There were no endoleaks, recurrent PSAs, or recurrent stenoses. One patient treated for aortoenteric fistula developed recurrent graft infection requiring excision.
CONCLUSIONS: Endovascular interventions for complications following open thoracic or abdominal aortic surgery can be performed with low morbidity and mortality in this high-risk patient cohort.
AUTHOR DISCLOSURES: J. P. Carpenter, Nothing to disclose, R. M. Fairman, Nothing to disclose; B. J. Herdrich, Nothing to disclose; B. M. Jackson, Nothing to disclose; E. H. Murphy, Nothing to disclose; G. J. Wang, Nothing to disclose; E. Y. Woo, Nothing to disclose.
Posted April 2012