Abstract
Background: Anastomotic pseudoaneurysm (APA) may occur as a complication after surgical reconstruction of the aorta. We evaluated the effectiveness of endovascular stent-grafting (SG) for APA.
Methods: Eight men with a mean age of 74 years, with 10 APAs after surgical reconstruction of the aorta and its branches underwent SG. The location of APAs included 4 in the descending aorta, 2 in the abdominal aorta, and 4 in the iliac artery. The average interval from the prosthetic graft placement was 10 years. Four patients were symptomatic. We performed coil embolization in 4 patients for prevention of type II endoleak. They were followed with computed tomography (CT) angiographic study at 1, 3, 6 months, and every 6 months after the procedure until 6 years and annually thereafter.
Results: SG placement was technically successful in 9 of the 10 APAs; post-procedure aortography showed complete exclusion of the APA. In these 8 APAs, CT obtained during the follow-up period (12–72 months) demonstrated complete thrombosis of the APA and patency of the stent-graft; no major complications developed. One patient suffered recurrence of the APA at the proximal descending thoracic aorta after SG placement at the distal site, but the external iliac artery was inadvertently dissected during the second SG placement and the procedure was stopped. One patient with perforation of the duodenum occurred SG infection after 1 month, so we performed surgical reconstruction.
Conclusion: SG exclusion of APAs is a minimally invasive and safe alternative to open surgical reconstruction.