Michael P. Harlander-Locke1, Peter F. Lawrence1, Gustavo S. Oderich2, Bernardo Mendes2, Michelle Mueller3, Misty D. Humphries3, Gregory J. Landry4, Jeffrey L. Ballard5, Preston Flanigan5, Christopher J. Abularrage6, William C. Pevec7, Nasim Hedayati7, Sam S. Ahn8
1Vascular Surgery, University of California Los Angeles, Los Angeles, CA; 2Mayo Clinic, Rochester, MN; 3University of Utah, Salt Lake City, UT; 4Oregon Health and Science University, Portland, OR; 5St. Joseph Hospital, Orange, CA; 6Johns Hopkins Hospital, Baltimore, MD; 7University of California Davis, Sacramento, CA; 8University Vascular Associates, Los Angeles, CA.
OBJECTIVES: Previous studies have combined anastomotic, catheter-induced and IFAA to achieve adequate numbers for analysis and have recommended repair of asymptomatic IFAA with diameters ≥2.5cm and all symptomatic IFAA. This study evaluates the contemporary management of IFAA using these criteria.
METHODS: Patients with IFAA were evaluated using a standardized, prospectively maintained database by a research consortium.
RESULTS: From 2002-2012, 236 IFAA were identified in 182 patients (mean age=72; M:F=16:1) at 8 institutions. Non-op mean diameter was 2.8±0.7cm; op diameter was 3.3±1.5cm. IFAA location was: CFA (191), SFA (34) and PFA (11). Synchronous aneurysms (mean=1.7/patient) occurred in the aorta (181), iliac (126), popliteal (96), hypogastric (63), mesenteric (17) arteries, and contralateral SFA (7) and PFA (2). Sixty-six percent of repaired aneurysms were asymptomatic; other indications included: claudication (18%), local pain (8%), nerve compression (3%), rupture (3%), acute thrombosis (1%), embolus (1%) and rest pain (0.5%). Acute complications (rupture, thrombosis, embolus) were associated (p<0.05) with FAA diameter >4cm and intraluminal thrombus, but not location. Mean diameter of symptomatic aneurysms was: rupture = 5.7±1.3cm, thrombosis = 4±1.1cm, and embolus = 3.6±.1cm. One hundred seventy-four IFAA were repaired with interposition or bypass graft; 3 underwent endovascular repair. There were 2 perioperative deaths at 30 days (MI, MSOF); op complications included wound infection (6%), seroma (3%), and bleeding (2%). No amputations occurred up to 5 years in either the non-op or op groups. Survival was: 3 months = 99% (138), 1 year = 92% (n=104), and 5 years = 81% (20) in operated patients.
CONCLUSIONS: This largest study of IFAA demonstrates that: 1) Acute complications did not occur in aneurysms smaller than 3.5cm; repair criteria for asymptomatic FAA should be changed to >3.5cm; 2) The presence of chronic FAA thrombus should reduce the threshold for elective repair; and 3) Criteria for symptomatic FAA repair should remain unchanged.
AUTHOR DISCLOSURES: C. J. Abularrage: Nothing to disclose; S. S. Ahn: Nothing to disclose; J. L. Ballard: Nothing to disclose; P. Flanigan: Nothing to disclose; M. P. Harlander-Locke: Nothing to disclose; N. Hedayati: Nothing to disclose; M. D. Humphries: Nothing to disclose; G. J. Landry: Nothing to disclose; P. F. Lawrence: Nothing to disclose; B. Mendes: Nothing to disclose; M. Mueller: Nothing to disclose; G. S. Oderich: Nothing to disclose; W. C. Pevec: Nothing to disclose.
Posted April 2013