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Reoperative aortic surgery
J S Matsumura1, W H Pearce, A Cabellon
1Department of Surgery, Northwestern University Medical School, Chicago, IL, USA. j-matsumura@nwu.edu
Cardiovascular Surgery (London, England)
|October 16, 1999
Summary
Reoperations for aortic surgery complications are reviewed. Metachronous aneurysms are the most common reason for reoperation, often asymptomatic and requiring routine screening after initial aortic surgery.
Area of Science:
- Vascular Surgery
- Cardiovascular Surgery
- Surgical Outcomes
Background:
- Long-term complications following conventional aortic surgery necessitate reoperative procedures.
- Patients undergoing reoperative aortic surgery present unique challenges and outcomes.
- Understanding trends in reoperative indications is crucial for patient management.
Purpose of the Study:
- To review the presentation and management of long-term complications after aortic surgery.
- To analyze outcomes of reoperative aortic procedures.
- To identify the most common indications for reoperation and associated risk factors.
Main Methods:
- A retrospective review of 97 consecutive patients undergoing 102 reoperative aortic procedures at a tertiary referral center.
- Data collected included presenting symptoms, demographics, risk factors, indications for initial and reoperations, operative techniques, and outcomes.
- Analysis of indications for reoperation, including subsequent aneurysms, graft occlusions, and infections.
Main Results:
- Metachronous aneurysms were the most frequent indication for reoperation (65 cases), followed by graft occlusions (25) and infections (24).
- One-third of subsequent aneurysms were asymptomatic and often undetected without routine screening.
- Elective repair of aneurysms had a 5.1% mortality rate, while emergent repair of ruptured aneurysms had an 88% mortality rate. Graft infections requiring total removal had a 17% mortality rate.
Conclusions:
- Metachronous aneurysm formation is the leading indication for aortic reoperation, often presenting asymptomatically.
- Routine computed tomographic (CT) examination every 5 years post-aortic surgery is advisable for early detection of aneurysms.
- While elective reoperations can be performed safely, emergent procedures for ruptured aneurysms or complicated graft infections carry high mortality risks.