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: 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.