Late Complications Following Aortic Aneurysm Repair

Abstract

Abdominal aortic aneurysm affects 5-10 % of men and 1,3% of women (Cosworth & Leng, 2007). Current treatment of aortic aneurysm is going through rapid changes. The first successful open repair with a homograft was performed in 1951 (Dubost et al. 1952). Initially, the aneurysm wall was completely removed which could lead to major complications. Creech modified the technique and combined repair with a graft with aneurysmorhapphy which simplified the technique and improved results (Creech, 1966). Late complications after open surgical repair are infrequent but also poorly monitored. It is generally assumed that if patients have survived this major surgical procedure, few complications occur. Endovascular aneurysm repair (EVAR) is gaining popularity since the mid-nineties (Parodi et al., 1991). Despite major technical improvements in endografts, follow-up is essential after endovascular repair. Recent studies reported up to 40% of aneurysms growing after EVAR, even in recent years (2004-2008) ( Schanzer et al., 2011). These growing aneurysms pose the vascular surgeon for new clinical problems which sometimes require unorthodox interventions. An overview of late complications of both open and endovascular abdominal aortic aneurysm repair is given along with specific solutions from the literature and our own experience. Table 1 summarizes the late complications and estimated incidence form the literature.