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Aneurysmal degeneration and changes in aortic diameter after open repair of complex abdominal aortic aneurysms
Tiziano Tallarita, MD, Gustavo S. Oderich, MD, Alexandre Pereira, MD, Thanila A. Macedo, MD, Manju Kalra, MBBS, Audra A. Duncan, MD, Peter Gloviczki, MD, Stephen Cha, MD, Thomas C. Bower, MD.
Mayo Clinic, Rochester, MN, USA.
Purpose: Rates of secondary aneurysmal degeneration and changes in aortic diameter have not been described in patients undergoing open repair of complex abdominal aortic aneurysms (cAAAs), yet these events may affect the choice and extent of repair. This study analyzed anatomical measurements of the aorta in a cohort of patients treated by open repair of cAAAs.
Methods: We retrospectively reviewed the clinical data and digital imaging studies of 201 patients treated by open repair of juxtarenal, suprarenal and type IV thoracoabdominal aortic aneurysms (2000-2010). All patients had clinical follow up and paired CT imaging studies obtained prior to and >12 months after the operation. Anatomical measurements included centerline of flow analysis to determine the location of normal aorta, defined by parallel aortic wall without aneurysm involvement. Axial imaging of the descending thoracic aorta and visceral aortic segments was used to determine changes in aortic diameter and development of new aneurysms. Serial anatomical measurements were analyzed taking into consideration weather the proximal graft anastomosis was placed within normal or abnormal aorta.
Results: There were 157 male and 44 female patients with mean age of 73±8 years. Median follow up was 39 months. The proximal graft anastomosis was placed in normal aorta in 150 patients and within abnormal segments in 51. A >3mm increase in aortic diameter at any location was noted in 116 patients (57%), averaging 5.5±3 mm and most frequently being noted at the supra-celiac level. Changes in aortic diameter at any location and adjacent to the anastomosis were noted in 80 (53%) and 24 (16%) patients who had anastomosis in normal aorta (mean 5.9±2mm), compared to 36 (71%) and 12 (24%) who had anastomosis in abnormal segments (mean 5.6±3mm). A new aortic aneurysm was diagnosed in 16 patients (8%), including 6/150 (4%) who had anastomosis in normal and 10/51 (20%) who had anastomosis in abnormal segments (P<0.05). Re-intervention for aortic aneurysm was needed in 6 patients (3%), including 2 (1%) who had para-anastomotic aneurysms and 4 (2%) who had descending thoracic aortic aneurysms.
Conclusion: Changes in aortic diameter are common (57%) after open repair of cAAAs. New aortic aneurysms were more common (20%) if the anastomosis was placed in abnormal segments, yet re-interventions for para-anatomotic aneurysms were needed in only 1% of patients.
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