Abdominal Wall Hernias After Open Abdominal Aortic Aneurysm Repair: Prospective Radiographic Detection and Clinical Implications

Abstract

The purpose of this study was to evaluate the prevalence of radiographically detected abdominal wall defects (AWD) after open abdominal aortic aneurysm (AAA) repair and to correlate it with prospectively gathered clinical information. Fine collimation, high-resolution, serial follow-up computed tomography (CT) scans for 99 patients in the control group of the Guidant Ancure device trial were reviewed. CT scans were obtained at 12, 24, 36, 48, and 60 months. AWDs, defined as discontinuity of the fascial layer with protrusion of abdominal contents, were identified. Clinical information regarding AWDs was retrieved from the study registry. The prevalence of AWD exceeds 20% and plateaus at 24 months. Eight patients (8%) had clinical evidence of ventral incisional hernias. One patient underwent repair, but no other patient developed hernia incarceration or intestinal obstruction or required additional procedures related to the AWD. AWDs are radiographic findings occurring frequently after open AAA repair. Radiographic evaluation is more sensitive than clinical observation for detection of ventral hernias. Clinical events and reinterventions related to these radiographic abnormalities are rare.

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References

Matsumura JS , Brewster DC , Makaroun MS , et al: A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysm. J Vasc Surg 37:262-271, 2003.

Makaroun MS : The Ancure endografting system: An update. J Vasc Surg 33:129-134, 2001.

Parodi JC , Palmaz JC , Barone HD : Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:494-499, 1991.

Carpenter JP , Baum RA , Barker CF , et al: Durability of benefits of endovascular versus conventional abdominal aortic aneurysm repair. J Vasc Surg 35:222-228, 2002.

Holzenbein TJ , Kretschmer G , Thurnher S , et al: Midterm durability of abdominal aortic aneurysm endograft repair: A word of caution. J Vasc Surg 33:46-54, 2001.

Makaroun MS , Chaikof E , Naslund T , et al: Efficacy of a bifurcated endograft versus open repair of abdominal aortic aneurysm: A reappraisal. J Vasc Surg 35:203-210, 2002.

Bernhard VM , Mitchell RS , Matsumura JS , et al: Ruptured abdominal aortic aneurysm after endovascular repair. J Vasc Surg 35:1156-1162, 2002.

Eskandari MK , Yao JS , Pearce WH , et al: Surveillance after endoluminal repair of abdominal aortic aneurysms. Cardiovasc Surg 9:469-471, 2001.

Chuter TA , Faruqui RM , Sawhney R , et al: Endoleak after endovascular repair of abdominal aortic aneurysm. Radiology 220:157-160, 2001.

10.

Cao P , Verzini F , Zannerri S , et al: Device migration after endoluminal abdominal aortic aneurysm repair: Analysis of 113 cases with a minimum follow-up period of 2 years. J Vasc Surg 35:229-235, 2002.

11.

Pollock JG , Travis SJ , Whitaker SC , et al: Endovascular AAA repair: Classification of aneurysm sac volumetric change using spiral computed tomographic angiography. J Endovasc Ther 9:185-193, 2002.

12.

Matsumura JS , Chaikof EL : Continued expansion of aortic necks after endovascular repair of abdominal aortic aneurysms. EVT investigators. Endo Vascular Technologies, Inc. J Vasc Surg 28:422-430, 1998.

13.

Illig KA , Green RM , Ouriel K , et al: Fate of the proximal aortic cuff: Implications for endovascular aneurysm repair. J Vasc Surg 26:492-501, 1997.

14.

Kalman PG , Rappaport DC , Merchant N , et al: The value of computed tomographic scanning in identification of vascular abnormalities after abdominal aortic aneurysm repair. J Vasc Surg 29:442-450, 1999.

15.

Bastounis E , Georgopoulos S , Maltezos C , et al: The validity of current vascular imaging methods in the evaluation of aortic anastomotic aneurysms developing after abdominal aneurysm repair. Ann Vasc Surg 10:537-545, 1996.

16.

Edwards JM , Teefey SA , Zierler RE , et al: Intraabdominal paraanastomotic aneurysms after aortic bypass grafting. J Vasc Surg 15:344-353, 1993.

17.

Pleumeekers HJ , De Gruijl A , Hofman A , et al: Prevalence of aortic aneurysm in men with a history of inguinal hernia repair. Br J Surg 86:1155-1158, 1999.

18.

Augestad KM , Wilsgaard T , Solberg S : Incisional hernia after surgery for abdominal aortic aneurysm. Tidsskr Nor Laegerforen 10:22-24, 2002.

19.

Hall KA , Peters B , Smyth SH , et al: Abdominal wall hernias in patients with abdominal aortic aneurysmal versus aortoiliac occlusive disease. Am J Surg 173:457-834, 1997.

20.

Adye B , Luna G : Incidence of abdominal wall hernia in aortic surgery. Am J Surg 175:400-402, 1998.

21.

Musella M , Milone F , Chello M , et al: Magnetic resonance imaging and abdominal wall hernias in aortic surgery. J Am Coll Surg 193:392-395, 2002.

22.

Holland AJ , Castleden WM , Norman PE , et al: Incisional hernias are more common in aneurysmal arterial disease. Eur J Vasc Endovasc Surg 12:196-200, 1996.

23.

Papadimitriou D , Pitoulias G , Papaziogas B , et al: Incidence of abdominal wall hernias in patients undergoing aortic surgery for aneurysm or occlusive disease. Vasa 31:111-114, 2002.