Lethal Complications Associated With Nonrestrictive Treatment of Abdominal Aortic Aneurysms

Extra-anatomic arterial reconstruction with ligation of common iliac arteries and embolization of the aneurysm for the treatment of abdominal aortic aneurysms in high-risk patients

“…Extra-anatomic bypass graft with aortic exclusion is not without potential disadvantages and complications. 7,8 The long-term patency rates of the more commonly performed aortoiliac and aortofemoral grafts are far superior to those of the axillofemorofemoral grafts. Five-year patency rates of axillofemorofemoral grafts range from 30% to 80% compared with 77% to 94% for aortofemoral grafts.…”

“…The literature is replete with case reports and studies of the mortality and morbidity associated with nonresective treatment of AAA. 7,8 The risk of subsequent aneurysm rupture causes the most concern, which is the precise complication of the disease we aim to treat. In a large survey of 120 patients, Lynch et al 8 documented a 34% rupture rate in patients treated with nonresective therapy.…”

Chronic complete thrombosis of abdominal aortic aneurysm: An unusual presentation of an unusual complication

“…Resnikoff et al 36 treated as much as 831 patients over 10 years, reporting a rupture incidence of 0.8%. Several other reports also questioned the safety of nonresective therapy for AAA 37,38 and, along with the advent of EV repair, led to its abandonment. 39 More recently, rupture of the thrombosed AAA 2 years following diagnosis, 40 as well as of a thoracoabdominal aneurysm 7 months after treatment with an AxBF, 41 has been reported.…”

“…Secondary infection of thrombosed AAA may contribute to the risk of rupture. 37,44 An aneurysmal thrombus represents an ideal bacterial culture medium. It is chronically contaminated in high percentage of clinically non-infected AAAs 45 and at constant risk of secondary hematogenous seeding from a distant focus of infection.…”

Management of Patients With Abdominal Aortic Aneurysms and Coronary Artery Disease: Current Trends

“…Further, ligation of the iliac vessels and thrombosis of the inferior mesenteric artery may well jeopardize pelvic circulation. There also exists the very real possibility of retrograde extension of the thrombus to the level of the renal arteries and the superior mesenteric artery Schwartz, Nichols, and Silver 52 reported ischemic colitis in 2 of 13 patients, and Cho et al 55 reported one death caused by thrombosis of the renal and superior mesenteric arteries and an overall operative mortality of 80%. Persistent advocates of these nonresective forms of therapy insist that such results reinforce the high-risk condition of the patients operated on, thus subtly using unsuccessful results as a rationale for their approach.…”