Limb Occlusion after Endovascular Repair of Abdominal Aortic Aneurysms with Supported Endografts

Maleux, Geert; Koolen, Marcel; Heye, Sam; Nevelsteen, André

doi:10.1016/j.jvir.2008.07.005

Cited by 82 publications

(67 citation statements)

References 16 publications

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“…1,3,4) The most common clinical presentation of endograft occlusion is acute limb ischemia, including numbness, sensory loss, rest pain, and loss of motor function. The reported incidence of acute limb ischemia is 50%-68%.…”

Section: Resultsmentioning

confidence: 99%

“…1,4,7) Endograft occlusion can present with chronic claudication without rest pain in 30%-50% of patients or may become evident during follow-up imaging study in 17%-20% of patients. 1,4,7) This patient experienced acute endograft occlusion 16 months postoperatively without any prodromal symptoms. Recent study reported that endograft morphology can be changed chronologically after implantation.…”

Section: Resultsmentioning

confidence: 99%

“…3,7) Notably, Gore Excluder endoprosthesis (W.L. Gore & Associates, Flagstaff, Arizona), one of the currently available third-generation endografts, has been reported to more suitable for complex iliac anatomy, with a limb occlusion incidence of 0%-1.4%, 4,9) which is lower than that of Zenith stent graft (4.8%-5.5%) 4,6,8) or Endurant endograft (Medtronic Inc, Minneapolis, Minnesota) (3.4%). 7) Treatment modalities for endograft limb occlusion are determined by the area and length of thrombosis, pattern of disease progression, clinical presentation, and severity of leg ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…Endograft occlusion, a serious late complication following EVAR, has been reported to have an incidence ranging from 1.1% to 7.1%. [1][2][3][4][5][6][7][8][9] Typically, endograft limb occlusion occurs unilaterally. If endograft occlusion occurs acutely in the bilateral limb or the main body of the endograft, its pathological condition may be similar to that of acute occlusion of the abdominal aorta, a emergency treatment.…”

Section: Introductionmentioning

confidence: 99%

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Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Shirasugi

Kimura

Yasuda

et al. 2015

Annals of Vascular Diseases

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We report a case of total occlusion of a Zenith bifurcated stent graft 16 months after implantation. A 72-year-old man was admitted to our hospital complaining of bilateral lower extremity numbness, followed by severe rest pain 4 h after sudden onset of symptoms. Computed tomography showed total occlusion of the endograft at the mid-portion of the main body. He underwent left axillobifemoral bypass using a reinforced polytetrafluoroethylene T-shaped graft, leading to resolution of symptoms 7 h after onset. Axillobifemoral bypass successfully relieved acute lower extremity ischemia caused by total occlusion of the abdominal aortic endograft.Keywords: abdominal aortic endograft, total occlusion, axillobifemoral bypass life-threatening disease associated with high morbidity and mortality. Here we report a case of abdominal aortic endograft total occlusion that was successfully managed with axillobifemoral bypass; in addition, we discuss the treatment strategies for this critical situation. Case ReportA 72-year-old man was admitted to an emergency department of a district hospital, complaining of sudden bilateral lower extremity numbness and severe rest pain. At the age of 62, he had undergone mechanical valve replacement for aortic valve stenosis and permanent pacemaker insertion for sick sinus syndrome at the same hospital. Sixteen months ago, he had undergone abdominal aortic endograft implantation for infrarenal abdominal aortic aneurysm at a different hospital. Preoperative computed tomography (CT) showed the maximum aneurysm diameter of 62 mm, the neck angulation 10) of 77°, and the terminal aorta diameter of 21 mm (Fig. 1). A Zenith endovascular graft (Cook Inc., Bloomington, Indiana) was implanted through the right femoral approach. The procedure was performed successfully and the postoperative course was uneventful. A postoperative CT showed the neck angulation of 56° and the terminal aorta diameter of 21 mm (Fig. 1). The patient was discharged from the hospital with no endoleak. Subsequently, he had been regularly followed-up for anticoagulation therapy at a local hospital. He had not experienced intermittent claudication previously.On further examination at the district hospital, a CT showed an abdominal endograft implanted from below the orifice of the renal arteries to the bilateral common iliac arteries with complete occlusion at the mid-portion of the main body (Fig. 2). The neck angulation was 54°, and the terminal aorta diameter of 21 mm (Fig. 2). Preoperative echocardiography showed that there was no obvious thrombus in the left atrium and the left ventricle, and around the mechanical aortic valve. A diagnosis of acute endograft occlusion was made. The patient was transferred to our hospital 4 h after the onset of symptoms for

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Shirasugi

Kimura

Yasuda

et al. 2015

Annals of Vascular Diseases

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“…This is a rare and challenging complication after EVAR and can lead to side-branch occlusion with subsequent ischaemia [34,39]. None of the previous studies has reported stent-graft dislocation after hybrid treatment (Fig.…”

Section: Graft Dislocationmentioning

confidence: 99%

Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

et al. 2009

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Purpose: Endovascular aneurysm repair of the infrarenal or thoracic aorta has been shown to be a less invasive alternative to open surgery. A combined aneurysm of the thoracic and abdominal aorta is complex and challenging; the involvement of renal and/or visceral branches requires new treatment methods. Methods: A hybrid approach is currently an accepted alternative to conventional surgery. Renal and/or visceral revascularisation enables subsequent stent-graft placement into the visceral portion of the aorta. Results: Knowledge of the surgical procedure and a precise assessment of the vascular morphology are crucial for pre-procedural planning and for detection of post-procedural complications. Multi-detector computed tomography angiography (MDCTA) combined with two-and threedimensional (2D and 3D) rendering is useful for pre-interventional planning and for the detection of postprocedural complications. Threedimensional rendering allows proper anatomical analyses, influencing interventional strategies and resulting in a better outcome. Conclusions: With the knowledge of procedurespecific MDCTA findings in various vascular conditions, the radiologist and surgeon are able to perform an efficient pre-interventional planning and follow-up examination. Based on our experience with this novel technique of combined open and endovascular aortic aneurysm treatment, this pictorial review illustrates procedure-specific imaging findings, including common and rare complications, with respect to 2D and 3D post-processing techniques.

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Complications of endovascular aneurysm repair

Orandi

Black

2013

Endovascular and Hybrid Therapies for Structural Heart and Aortic Disease

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Limb Occlusion after Endovascular Repair of Abdominal Aortic Aneurysms with Supported Endografts

Cited by 82 publications

References 16 publications

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

Complications of endovascular aneurysm repair

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