Fate of proximal aorta following open infrarenal aneurysm repair

Open repair of abdominal aortic aneurysm (AAA) is considered a stable and durable vascular procedure when compared with the more recent endovascular approach. A process of remodeling and progressive degeneration may occur after open surgery in the aorta proximal to the repair, predisposing to proximal recurrent aneurysm formation. Surgical repair of the false aneurysm carries a high rate of perioperative complications, including spinal cord ischemia and renal insufficiency. The literature is conflicting on the frequency of proximal false-aneurysm formation, but an average neck dilation of between .2 and .6 mm per year has been reported. Importantly, disease progression may be the most common underlying culprit for proximal false-aneurysm formation. These findings argue for careful follow-up after aneurysm repair using high-quality imaging studies to detect failures and the potential for false-aneurysm formation.