Management of abdominal aortic graft complications.

Abstract

This study reviews the outcome of 61 patients who underwent 66 reoperations for complications of aortic grafts. There were 25 patients with false aneurysm of an aortic anastomosis and 41 patients with graft infection, 17 of whom had involvement of the gastrointestinal tract. Significant late complications of aortic grafting occurred in 2% of patients. The mode of clinical presentation, the clinical characteristics, and outcome in these patients has not been emphasized. This study reviews our experience with patients with complications of aortic grafts requiring graft excision or replacement with a view towards identifying prominent and important clinical characteristics and predictors of successful treatment. Patients with involvement of the gastrointestinal tract have higher mortality and morbidity than patients with simple aortic graft infection or those who require aortic graft replacement for pseudoaneurysm formation at the aortic anastomosis. These patients require longer hospitalization, more blood transfusion, and have higher operative and long-term mortality. Revascularization of the lower extremities should be attempted and has a high rate of limb salvage although revision or thrombectomy may be required. The authors recommend complete graft excision and extra-anatomic bypass for patients with aortic graft infections.