[Proximal abdominal aortic aneurysms after infrarenal aortic reconstruction]

The failure of infrarenal aortic open reconstruction due to sterile sovranastomotic abdominal aortic aneurysm (SS-AAA) is a rare and complex long-term complication. Even if they undergo the same treatment, is necessary to distinguish between true aneurysmal degeneration of proximal aorta and chronic proximal aortic anastomosis sterile rupture with consequent false aneurysm formation: we call proximal para-anastomotic abdominal aortic aneurysm (PPA-AAA) the first and proximal anastomotic false abdominal aortic aneurysm (PAF-AAA) the latter. The etiology of this complication is exclusively degenerative and it occurs in the absence of infection, which has totally different features. SS-AAA have been reported in 1 to 4% patients, but the available studies differ about patient selection and diagnostic methods. According to these considerations we can suppose the real incidence greater and near to 25% in over 10 years follow-up patients. Clinical findings of PPA and PAF-AAA before rupture are poor and this consideration emphasizes the necessity of a long term ultrasound follow-up. Best diagnostic tools after echographic detection of SS-AAA are spiral TC scan and MR imaging. Due to image accuracy, the short time necessary to take the images and availability spiral TC has taken the place of standard TC and arteriography. Scar tissue field and visceral vessels involvement with consequent proximal clamping are the main problems in open repair of SS-AAA. Elective open repair mortality rate varies from 0 to 17% and increases dramatically after rupture. Endovascular repair at the present is suitable only for hardly selected cases, because of frequent visceral involvement. We report our 17 patients series (8 PPA and 9 PAF-AAA), which we have observed friom 1991 to 2003 in a total amount of 1363 abdominal aortic aneurysms treated. All the patients have been treated with elective open repair with a global perioperative mortality of 6% (1/17).