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Erik Jan Mulder, MD; J. Hajo van Bockel, MD, PhD; Jacinta Maas, MD; Pieter J. van den Akker, MD, PhD; Jo Hermans, PhD

Arch Surg. 1998;133:45-49.

Objective  To determine the morbidity and mortality of surgical treatment of false (anastomotic) aneurysms, we analyzed the results of 158 consecutive surgical procedures for repair of false aneurysms that were detected as a result of a surveillance program after aortic reconstruction with a prosthesis.

Design  Retrospective analysis of patient data from a vascular registry that included information on the long-term follow-up of our patients.

Setting  A university hospital (tertiary referral center) in the Netherlands that has been performing vascular reconstructive surgery since 1958.

Patients  We performed 158 surgical procedures on 135 patients with 220 noninfected false aneurysms. Using a yearly surveillance program, the false aneurysms were detected at a mean interval of 8 years after the initial reconstruction. Most patients (60%) were asymptomatic. The operation was performed as an emergency in 25 instances (16%).

Results  The mortality rate of patients receiving nonsurgical treatment was very high (61%) owing to documented rupture (11 of 18 patients). The intraoperative death rate was 7.6% per procedure. This was higher for emergency (24%) than for elective procedures (4.5%).

Conclusions  Conservative follow-up carries a very high mortality rate, as does emergency surgery for a false aneurysm. However, the intraoperative mortality rate of elective reconstruction of a false aneurysm can be in the same range as that of elective primary aortic reconstruction. Therefore, we advocate a surveillance program, including yearly ultrasound studies, after prosthetic aortic reconstruction for the timely detection and elective repair of all false aneurysms.

From the Departments of Surgery, Leiden University Medical Center, Leiden (Drs Mulder, van Bockel, and Maas) and Alkmaar Medical Center, Alkmaar (Dr van den Akker); and the Department of Medical Statistics, University of Leiden (Dr Hermans), the Netherlands.

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