Long-term results of surgical treatment of aneurysms of digestive arteries.

Background: The aim of this study was to document the long-term results of open surgical treatment of aneurysms of the digestive arteries.

Methods: Between January 2000 and March 2010, 60 patients were operated on for 78 aneurysms of the digestive arteries at our institution. The mean age of patients was 61 years (31-84 years). The average lesion diameter was 33 mm (range 10-90 mm). Topographic distribution involved the coeliac trunk in 23 cases (30%), hepatic artery in 20 (26%), splenic artery in 19 (24%), superior mesenteric artery in 11 (14%), gastroduodenal artery in 3 (4%), and pancreaticoduodenal arteries in 2 (3%). Twenty patients (33%) were symptomatic, 1 of whom presented with aneurysmal rupture (1.7%). Follow-up was prospective and an actuarial analysis was carried out. Only 3 patients (5%) were lost to follow-up.

Results: Hospital mortality was 1.7% (upper gastrointestinal bleeding from gastric metastases of a kidney cancer). Postoperative complications were mainly respiratory (18%), digestive (18%), and renal (13%). Five reintervention procedures (8%) were necessary: 2 for colonic ischemia; 1 for intestinal bleeding; 1 for secondary graft infection due to peritonitis; and 1 for drainage of an acute pancreatitis. The average follow-up was 42 months (range 1-120 months). The actuarial survival rates were 98% at 1 month and 1 year, and 97% at 5 and 10 years, respectively. One late death occurred at 22 months (bronchopulmonary cancer). Three late reinterventions were carried out: 2 re-establishments of digestive continuity and 1 embolization for a recurrent aneurysm 7 years after the initial operation. The primary patency rate of the revascularizations was 98% at 1 month and 1 year, and 95% at 5 and 10 years. The rates of indemnity of restenosis or thrombosis were 98% at 1 month and 1 year, and 95% and 93% to 5 and 10 years, respectively. The rates of freedom of reintervention on bypasses were 98% at 1 month and 1 and 5 years, and 97% at 10 years.

Conclusion: Open surgical treatment of aneurysms of the digestive arteries offers excellent long-term results in terms of patency. It is with these late results that endovascular techniques will have to be compared to define the best therapeutic strategy.