Open surgery for abdominal aortic aneurysm or aorto-iliac occlusive disease--clinical and ultrasonographic long-term results.

Objective : To determine postoperative and long-term outcome and assess the relevance of abdominal ultrasound (US) after surgery for abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD). Methods : Records of 1704 consecutive patients having graft implantation from 1988 to 2000, either for AAA (n = 1144) or for AIOD (n = 560), were reviewed. In 2006, follow-up was 9180 patients-years for the AAA group and 5450 patients-years for the AIOD group. Among 1006 alive patients, 377 were invited randomly for US and clinical examination. Results : Hospital death occurred in 99 patients (8.6%) of the AAA group (53% in ruptured and 2% in elective AAA), and in 18 patients of the AIOD group (3.2%). There were 581 late deaths, including eight due to prosthesis infection, one to pseudo-aneurysm rupture, and one to graft thrombosis (0.6% graft-related mortality). Prosthesis thrombosis occurred in 32 patients (26 in AIOD group, p < 0.001), and graft infection in 26 (17 in AAA group, p < 0.01). Pseudo-aneurysms developed in 90 patients (68 in AIOD group, p < 0.001), including eight at the proximal aortic, one at the distal aortic, two at the iliac and 79 at the femoral anastomosis. In the AAA group only, surgery was required for a new thoraco-abdominal and pararenal aneurysm in eight and four patients, respectively, while US evidenced a 26-35 and a 36-50 mm supraanastomotic aortic dilatation in 65 (32%) and in 14 (7%) patients, at a mean follow-up of 10.5 and 9.3 years, respectively. Conclusion: Long-term results are good after open surgery for AAA or AIOD. Prosthesis infection and anastomotic pseudo-aneurysm are the main causes of graft-related mortality and morbidity, respectively. Because of high incidence of asymptomatic supraanastomotic aortic dilatation, all patients with a history of AAA repair should have regular abdominal US.