Early Complications in Endovascular Treatment of Abdominal Aortic Aneurysm

Abstract

Abstract.Objective : The incidence of perioperative complications during endovascular repair of abdominal aortic aneurysm (EVAR) is reported in limited series. The aim of this study is to evaluate a multi-center survey of unexpected intraprocedural critical events of EVAR. Methods : A questionnaire relative to intraprocedural complications during EVAR was sent to major vascular surgery divisions in Italy. Eleven answered to the survey. The data obtained are relative to 1696 procedures. Results : A wide range of incidence of critical events was observed, from a lower value of 2.7% to a higher value of 68.8% (mean 21.16%). The problems relative to the insertion phase of the delivery system were 7.7%. Endoleaks were reported in 5.5% of cases. Stent graft release was problematic in 0.4% of cases and in another 0.4% there was a problem in shaft retrieval. Unintentional coverage of renal or polar arteries occurred in 0.8% of the procedures ; hypogastric arteries were unwillingly excluded in 2.7% of cases. Aortic or iliac artery rupture had an incidence of 0.7% ; arterial dissection occurred in 0.9%, atheroembolism in 0.5%, lower limb ischemia due to graft limb kinks in 0.7% and to occlusion in 0.9%. Conclusions : Perioperative critical events represent a serious problem only in few cases of EVAR ; they are common but in many cases not predictable ; in most circumstances they can be easily corrected with adjunctive manoeuvres during the same procedure. There is a highly significant correlation between the total workload and the incidence of critical events ; these do not appear to be related to the learning curve.

Physiologic Cardiovascular Strain and Intrinsic Wave Imaging

“…An AAA may rupture if it is not treated, and this is ranked as the thirteenth most common cause of death in the U.S. and as the most common aneurysm type (114). Current AAA repair procedures are expensive and carry significant morbidity and mortality risks (115)(116)(117)(118)(119)(120). Despite the advent of sophisticated imaging techniques over the past three decades, none of the available imaging techniques is entirely satisfactory for detection and monitoring of this often silent and deadly disease.…”

Biomechanics of abdominal aortic aneurysm

“…An AAA may rupture if it is not treated, and this is ranked as the 13th most common cause of death in the US (Patel et al, 1995). Current AAA repair procedures are expensive and carry significant morbidity and mortality risks (Darling et al, 1977;Wain et al, 1998;Turnipseed et al, 2001;Velazquez et al, 2001;Gabrielli et al, 2004;Ghansah and Murphy, 2004;Blankensteijn et al, 2005;EVAR trial participants, 2005a, b;Goueffic et al, 2005;Schouten et al, 2005;van Marrewijk et al, 2005;Dillavou et al, 2006). Because most patients with AAA are elderly, and/or have co-morbid conditions, and because current repair techniques are not without complications (Moore and Rutherford, 1996;Blum et al, 1997;Wain et al, 1998;Cuypers et al, 1999;Zarins et al, 2000;Brewster, 2001;Hallin et al, 2001;Sicard et al, 2001), the clinician is faced with a dilemma: deciding when the risk of AAA rupture justifies the risks associated with repair.…”

Endovascular management of iliac rupture during endovascular aneurysm repair

“…Others have reported an incidence of iliac rupture of 0.5% to 1.5% with endograft repair of abdominal aneurysms. 16,17 Women were at higher risk for rupture (76% vs 19%; P Ͻ .0001). All ruptures occurred during the use of devices with a Ն20F delivery system.…”