Postdissection Abdominal Aorto-Iliac Aneurysm Open Repair: A Surgical Technique Description and Systematic Review of the Literature

Abstract

Background: Postdissection abdominal aortic aneurysms (pDAAA) may develop in up to 7% of patients affected by aortic dissection. However, there is no consensus on the optimal management. Different endovascular and open surgical techniques have been reported. This case series describes the open surgical technique employed at a tertiary vascular surgery center to manage this complex pathology to allow future treatment of the visceral aorta if needed. A systematic review of the relevant literature on surgical and endovascular management of pDAAA was conducted.

Method: Consecutive patients surgically treated at a single center for pDAAA metachronous to a Stanford type A or type B aortic dissection from January 2018 to March 2023 were retrospectively retrieved. The surgical technique we employed entails the use of large-diameter bifurcated grafts (≥9 mm branches) with longer main body, fenestration of the septum at renal arteries ostia and landing on a common femoral artery in case of small caliber iliac arteries (<8 mm) to provide a suitable landing zone and access route for future endovascular thoracoabdominal repair in case of subsequent aneurysmal degeneration. The primary outcome was 30-day mortality. Secondary outcomes were major complications, late mortality, aortic-related mortality, and aortic-related reinterventions. Then, a systematic review of the literature until March 2023 was conducted.

Results: Five patients were included, all males with a mean age of 61 years. The 30-day mortality was 0. One patient suffered from postoperative acute kidney injury and acute distress respiratory syndrome, and another one underwent repeat laparotomy for abdominal seroma. The mean follow-up was 44 months with no aortic-related reinterventions to date. One patient died from nonaortic-related causes 9 months after surgery.

Conclusions: Open repair of pDAAA appears to be an effective treatment in selected patients, with low mortality rates, and technical choices should consider future endovascular treatment of the thoracoabdominal aorta.