Abdominal aortic aneurysm repair in patients with end stage renal disease.

OBJECTIVE: Abdominal aortic aneurysm (AAA) in patients with end stage renal disease (ESRD) represents a challenging therapeutic problem. This study was undertaken to analyze the surgical outcome of AAA repair in patients with ESRD and discuss the optimal peri-operative management of problems that resulted. METHODS: Between January 1995 and January 2005, 11 patients with ESRD underwent abdominal aortic aneurysm repair. All patients were under chronic haemodialysis. Risk factors related to surgical morbidity were evaluated. RESULTS: The average age was 68 years (57-84 years). Nine patients were men: 8 were hypertensive, 6 had diabetes, 4 had coronary artery disease, 3 had suffered a previous stroke, 3 had prior myocardial infarct and 8 were smokers. The duration of haemodialysis was 19 months (range 2 to 46 months). Five of the 11 patients had bilateral common iliac aneurysms in addition to the abdominal aortic aneurysm. The average diameter of infrarenal AAA was 6 cm (4.8-7.5). The mean duration of operation was 191 min. All patients underwent haemodialysis on the day before operation with an average period of 8.5 hours (6-12) and 2 to 20 hours postoperatively. The mean follow-up was 11.5 months (range 1 to 93 months). None of the patients died during the 30-day postoperative period. Two patients died from heart failure 3 and 7 months later. CONCLUSION: Abdominal aortic aneurysm can be repaired in patients with end stage renal disease with good results, despite the increased morbidity and mortality of this population.

[Purulent arthritis of the knee joint and septic microembolism of the foot as postoperative complications of an infected femoral anastomosis aneurysm]. / Kniegelenkspyarthros und septische Mikroembolien am Fuss als postrekonstruktive Komplikation eines infizierten femoralen Anastomosenaneurysmas.

Septic peripheral embolism due to infective complication of vascular infrainguinal procedures has been occasionally reported. The combination, however, of purulent arthritis of the knee joint and septic microembolism of the foot, as consequence of an infected pseudoaneurysm, is a very rare entity. We report a case of an infected anastomotic femoral aneurysm, following an iliofemoral "in situ repair" which was complicated with purulent arthritis of the knee joint and multiple small necrotic lesions of the plantar surface of the foot. Treatment included removal of the infected graft, an extra-anatomic revascularization and arthrotomy with pus evacuation. The patient had an uneventful postoperative course and remained well at four-year follow-up, with a mild dysfunction in the knee joint flexion.