"Redo" surgery after operations for aneurysm and occlusion of the abdominal aorta

During a 20 year period, 1,287 patients were submitted to arterial reconstruction for aneurysm and occlusion of the aorta and iliac arteries. Good results were obtained in 1,230 (95.6 percent). Of these, 83 (6.4 percent) returned for reoperation. Reoperation was performed also in 18 patients operated upon elsewhere. Thus this series of cases of reoperation consists of 101 patients. The most common cause for reoperation and interval after initial procedure were recurrent obstruction--44 to 90 months, false aneurysm--94 months, and infection--25 months. The most common complication in patients treated initially for aneurysm was false aneurysm and recurrent obstruction in the patients treated for aortoiliac artery occlusion. Infection was rare and occurred in both groups. False aneurysm was due to fragmentation of suture in most cases and recurrent obstruction was related to progression of the disease, the type of original procedure employed, and technical factors. Although various methods of treatment were employed, the preferred are (1) aneurysm replacement for false aneurysm, (2) bilateral aortofemoral or aortapopliteal bypass for recurrent obstruction with profundaplasty when necessary, and (3) bilateral axillofemoral or axillopopliteal bypass and graft removal for infection. The results of reoperation were considered to be satifactory with survival in 89 (88 percent) and good functional results in 84 (94 percent) of survivors. Amputation was necessary in only five (6 percent) patients.