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Value of Graft Surveillance After Open Aortic Operations
Rhusheet Patel, M.S., Sarah Wartman, M.D., Fred Weaver, M.D., Karen Woo, M.D..
Keck School of Medicine of USC, Los Angeles, CA, USA.

OBJECTIVES:To examine the late outcomes of open aortic operations and the value of routine post-operative surveillance duplex in identifying late graft-related complications.
METHODS: All open aortic operations performed at a single institution between 1998 and 2012 were retrospectively reviewed. All patients were scheduled for yearly post-operative surveillance duplex. Patients who had at least 30-day follow up and at least one surveillance duplex were analyzed.
RESULTS: 238 open aortic operations were performed during the study period, 140 of which met the inclusion criteria. Mean follow-up was 3.9 years. Mean age was 69 with 74% male. 111 (79%) had hypertension, 20 (14%) were diabetic and 38 (27%) had coronary artery disease. Chronic obstructive pulmonary disease (COPD) was present in 13 (9%) and 28 (20%) had a history of a previous aortic operation. The indication for operation was aortic aneurysm in 105 (75%), aortic dissection in 7 (5%) and occlusive disease in 28 (20%). A tube graft was performed in 65 (46%) and the proximal anastomosis was in the infra or juxta-renal position in 125 (90%). Overall survival at one year was 100% and 85.3% at five years. A mean of three surveillance duplexes was performed per patient. Sixteen (15%) patients required a graft- related operation at a mean of 2.4 years. Indications included: anastomotic aneurysm/pseudoaneurysm (6), limb occlusion (5), graft stenosis (2) and graft infection (1). The indication for operation was identified by surveillance duplex in four of the 16 cases. The remainder were identified by physical exam and/or clinical presentation. Re-intervention-free survival (RIFS) was 97.7% at one year and 77.4% at five years. On multivariable analysis, RIFS was decreased by a history of prior aortic surgery (HR 2.44, 95% CI 1.04-5.74) and history of COPD (HR 2.69, 95% CI 1.17-6.21). RIFS was improved by the use of a tube graft during the index operation (HR 0.71, 95% CI 0.53, 0.96).
CONCLUSIONS:Open aortic operations are durable with few long-term complications. When complications occur, the majority are identified by physical exam and clinical presentation. Routine surveillance duplex identifies few findings that lead to re-intervention. Patients with COPD, history of prior aortic surgery and a non-tube graft reconstruction are at greater risk for re-intervention and may benefit from surveillance duplex after open aortic operations.


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