Para-anastomotic Aneurysm and Secondary Complications After Open Repair Surgery for an Abdominal Aortic Aneurysm

Abstract

Open repair surgery (ORS) for an abdominal aortic aneurysm (AAA) remains an important treatment option, but the incidence of para-anastomotic aneurysm and secondary complications are unclear. The purpose of this study was to estimate the incidence of para-anastomotic aneurysm and to reveal secondary complications through routine annual computed tomography (CT) imaging. We enrolled 147 patients who underwent ORS for AAA and received routine CT imaging surveillance at Ishinomaki Red Cross Hospital from January 2006 to December 2015. All patients were monitored until August 2019. The follow-up period was 7.1 ± 2.7 years (median, 6.8 years). The total follow-up time of all patients was 1041.1 years, and 958 CT images were obtained (patients received an average of 0.92 CT scan/y). Survival rates at 5 and 10 years were 87.4% and 67.0%, and median survival time was 11.5 years. A proximal para-anastomotic aneurysm was detected in five patients (3.4%). Four of the five patients had an aneurysmal dilation at the first ORS (proximal diameter >25 mm), which enlarged during the follow up; thus, a de novo proximal para-anastomotic aneurysm was observed in one patient (0.7%). The time between surgery and the diagnosis of all proximal para-anastomotic aneurysms was 5.7 ± 1.4 years, and the de novo proximal para-anastomotic aneurysm was detected at 11.8 years. The incidence of all para-anastomotic aneurysms at 5 and 10 years was 2.2% and 3.6%, and the incidence of the de novo para-anastomotic aneurysm was 0% at 5 and 10 years. Nine patients (6.1%) had synchronous thoracic aortic aneurysms (TAAs), and the TAAs enlarged (>5 mm) in seven patients during the follow-up period. The time between surgery and TAA enlargement was 3.1 ± 0.5 years. Metachronous TAAs were detected in seven patients (4.8%), and the time between surgery and the diagnosis of metachronous TAA was 5.6 ± 0.8 years. Finally, 16 of 143 patients (10.9%) had a TAA. Neoplasms were detected in 18 of 147 patients (12.2%), and the most dominant neoplasm was lung cancer in seven patients. Although the incidence of para-anastomotic aneurysms was low, TAAs and lung cancer were diagnosed with a certain probability. CT imaging surveillance of AAAs should include not only the abdomen and pelvis but also the chest.