[Late complications of abdominal aortic prostheses: false aneurysms and aorta-digestive fistulas]

Pseudoaneurysms of the abdominal aorta (PAAA) are late complications of aortic reconstruction that occur with an incidence varying from 4.8 to 6.3% associated with an operative mortality of 21 to 35%. Between 1987 and 1994, 16 patients with a PAAA (14 men and two women, with a mean age of 69.5 years, ranging from 55 to 82 years) were treated in our unit. An anastomotic rupture with a pseudoaneurysm diameter varying from 50 to 75 mm was present in five cases (group 1). The eleven other cases were aorto-enteric fistula, isolated in six cases (group 2) and associated with local and/or general sepsis signs in five cases (group 3). The mean interval from the time of the primary aortic graft, which was performed as treatment for aortic aneurysm in six cases and for aortoiliac occlusive disease in 10 cases, and the diagnosis of the PAAA, was 11.3 years. An in situ replacement of the aortic graft with an interposition of the greater omentum was performed in each patient of groups 1 and 2, associated with an enteric restoration in the latter. Group 3 patients were treated by removal of the infected graft with closure of the aortic stump and extra-anatomic bypass. During the post-operative period, five deaths (31%) and one limb amputation (6%) occurred, i.e. one death in group 1 (20%), one in group 2 (17%) and three in group 3 (60%) associated with a limb amputation (20%).(ABSTRACT TRUNCATED AT 250 WORDS)