ABSTRACT
We report a case of successful surgical treatment for an aortic anastomotic false aneurysm associated with a graft-duodenal fistula after abdominal aortic aneurysm repair. A 63-year-old man was admitted with melena and an aortic anastomotic false aneurysm after prosthetic graft replacement 8 years previously. CT scan demonstrated an aneurysm with a maximum diameter of 70mm at the proximal anastomotis of the prosthetic graft. Gastroduodenoscopy revealed no bleeding site in the stomach or the first and second portions of the duodenum. Therefore, we performed an emergency operation under a diagnosis of an aortic anastomotic false aneurysm associated with a graft-duodenal fistula. The aneurysm was replaced with interposition of a new prosthetic graft via a thoracoabdominal approach. The fistula was repaired by covering the duodenum with the jejunum through a left pararectal laparotomy. The postoperative course was uneventful, and there was no evidence of graft infection at 14 months after the operation.
ABSTRACT
It is well known that patients with abdominal aortic aneurysms (AAA) have a high incidence of coronary artery disease (CAD), and that the major cause of death in patients undergoing aneurysmectomy is acute myocardial infarction. A total of 53 patients (mean age, 71 years) underwent elective repair of AAA between January 1991 and November 1999. In an attempt to reduce early and late mortality caused by myocardial infarction, coronary angiography (CAG) was performed in all cases. Significant CAD was found in 23 patients (43%), with triple vessel disease in 1 patient (2%), double vessel disease in 5 patients (9%), single vessel disease in 16 patients (30%) and left main in 1 patient (2%). Ten patients (19%) in whom CAD was detected by CAG had no history of CAD and displayed no ischemic findings on ECG. In 4 patients (8%), AAA repair was performed 2 (mean) months after coronary artery bypass grafting (CABG). Percutaneous transluminal coronary angioplasty (PTCA) was performed in 8 patients (23%) 19 days (mean) prior to AAA surgery. No patient had a perioperative myocardial infarction either following coronary revascularization (CABG and PTCA) or AAA resection. Moreover, there was only one operative death after abdominal aneurysmectomy (2%), in a patient who was 70 years old with chronic hemodialysis and who died due to multiple organ failure caused by uncontrollable adhesional ileus. The results of this study emphasize the importance of preoperative routine coronary angiography following coronary artery revascularization to enhance the operative outcome of AAA repair.