Revision of the proximal aortic anastomosis after aortic bifurcation surgery

The durability of endovascular repair of para-anastomotic aneurysms after previous open aortic reconstruction

“…[4][5][6][7][8] One report compared 16 open repairs with 10 EVPAR procedures in patients who were candidates for endovascular repair, showing higher morbidity and complication rates after open repair than after EVPAR. 24 Furthermore, blood loss, procedural time, and hospital length of stay were significantly reduced for EVPAR.…”

“…2,3 However, these open surgical reinterventions are technically challenging, with mortality rates of 8% to 70% and morbidity rates of 70% to 83%, which are considerably higher than the rates associated with primary prosthetic reconstructions. [4][5][6][7][8] Endovascular PAA repair (EVPAR) allows for local or regional anesthesia without requiring dissection through the scars of previous operations and might be preferred instead of repeated open repair. 9 Except for case reports, a few small case series have suggested that endovascular exclusion of noninfected PAAs after previous abdominal aortoiliac surgery is feasible, with low perioperative mortality and morbidity.…”

Fenestrated and branched endograft repair of juxtarenal aneurysms after previous open aortic reconstruction

“…[7][8][9][10][11][12] Additionally, the redo nature of the surgery leads to added technical difficulty, morbidity, mortality, and a prolonged recovery time. [12][13][14][15] We have previously reported our early results with fenestrated and branched endografting in a heterogeneous group of patients with previous open and endovascular aortic reconstructions. 4 Although we now preferentially repair all juxtarenal aneurysms using endovascular means, we have identified specific difficulties associated with the management of patients after a prior open aneurysm repair.…”

Treatment for Aortic Graft Infection

“…We had no idea how to deal with the three reconstructed branches after a total excision, and we thus attempted conservative graft preservation. We believe that a conservative graft preservation approach is worthwhile in patients under the following conditions: (1) the graft is patent, (2) there is no pseudoaneurysm, (3) there has been no evidence of bleeding, (4) there is no systemic sepsis, and (5) the graft infection demonstrates no specific organisms such as Pseudomonas sp.…”

“…The incidence of aortic graft infection is not high, ranging from 0.4% to 3.1%, [1][2][3][4][5] but it remains one of the most challenging problems in aortoiliac reconstructive surgery. Improvements in an early surgical outcome have shifted attention to problems related to late complications.…”