Recurrent aneurysms: late complication for patients previously submitted to graft replacement for abdominal aortic...

The possibility to perform easy and cheap ultrasonographic examinations of the abdomen allows us to face the problem of possible development of new paraanastomotic aneurysms or aneurysms on native arteries in subjects already submitted to endoaneurysmectomy of the abdominal aorta. The idea of planning accurate programs of ultrasonographic follow-up of operated patients is sustained by the hypothesis that the aortic aneurysm is an expression of a systemic disease due to a connectival defect of genetic nature.

Two different follow-up experiences are described: the first was a simple follow-up based only on clinical evaluation of patients previously submitted to aortic surgery in the last ten years at the Department of General and Cardiovascular Surgery of the University of Milan, and the second experience a planned follow-up programme based on instrumental evaluation of the patients.

Thirty-one cases of recurrent aneurysms of native arteries in 13 subjects already operated for AAA from 3 to 13 years before are described. Despite the patients were evenly inserted in a clinical follow-up, as a matter of fact, 25 of these lesions were detected during occasional investigations performed for other reasons or for rupture, while during the last two years, the planned ultrasonographic follow-up of 95 patients detected 6 new aneurysms.

Incidental detections of new paraanastomotic true aneurysms or ectasia of native arteries far from the graft are more and more frequent in patients already submitted to aortic replacement for abdominal aneurysm. In the international literature only few papers have been published about perspective studies based on instrumental follow-up of operated patients. The planning of such controls is mandatory, at present, also in order to evaluate the clinical development of aneurysmatic disease.