Giant Para-Anastomotic Aneurysms Following Open Abdominal Aortic Surgery: Open Surgery or Endovascular Management? Report of Two Cases and Literature Review Publisher



Salimi J^{1, 2} ; Ahrabi A²
Source: International Journal of Surgery Case Reports Published:2025

Abstract

Introduction and importance: Para-anastomotic aneurysms (PAAs) represent a late complication of open surgical repair for occlusive or aneurysmal disease of the abdominal aorta. Due to limited literature and management challenges, we present two cases of PAAs and review existing evidence. Case presentation: Case 1: A 66-year-old man with a history of open infrarenal aortic aneurysm repair presented with mild abdominal pain and a pulsatile mass. Computed tomographic angiography (CTA) showed a juxta-renal PAA near the prior proximal anastomosis. The pseudoaneurysm was managed through fenestrated endovascular aortic aneurysm repair (FEVAR) with four fenestrations.Case 2: A 76-year-old man with a history of open repair for aortic occlusive disease presented with chronic abdominal pain. CTA revealed two PAAs at the distal anastomosis of the prior aortoiliac graft. The patient underwent open repair surgery. Clinical discussion: The FEVAR approach avoids redo laparotomy, reducing risks of blood loss, and splanchnic injury. However, prior open repair requires careful endograft design, considering the graft's configuration, reduced compliance, and altered visceral anatomy. For distal anastomotic aneurysms, open repair was chosen due to fewer challenges from adjacent structures. Conclusion: Based on our experience, FEVAR is effective for juxta-renal PAAs near the proximal anastomosis, while open repair is preferred for PAAs at the distal anastomosis. Further large-scale, long-term studies comparing these treatments are warranted. © 2025 The Authors