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Semin intervent Radiol 2009; 26(1): 003-009
DOI: 10.1055/s-0029-1208377
© Thieme Medical Publishers

Complications after Endovascular Aneurysm Repair

Geert Maleux1 , Marcel Koolen1 , Sam Heye1
  • 1Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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Publication History

Publication Date:
16 March 2009 (online)

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ABSTRACT

Endovascular aneurysm repair (EVAR) has become an established technique for the treatment of many infrarenal aortic aneurysms. Although EVAR is obviously less invasive than open surgical repair, it is not free of complications. These can potentially result in severe morbidity or even mortality, stressing the need for an early detection and subsequent treatment. In this review article, the pathophysiology, diagnosis, and treatment of the most common complications of EVAR, with the exception of endoleaks, are described.

KEYWORDS

Aorta - aneurysm - stents - prostheses - complication

REFERENCES

  • 1 Blankensteijn J D, de Jong S E, Prinssen M et al.. Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms.  N Engl J Med. 2005;  352 2398-2405
    CrossrefPubMedSearch in Google Scholar
  • 2 Katzen B T, MacLean A A. Complications of endovascular repair of abdominal aortic aneurysms: a review.  Cardiovasc Intervent Radiol. 2006;  29 935-946
    CrossrefPubMedSearch in Google Scholar
  • 3 Liaw J V, Clark M, Gibbs R, Jenkins M, Cheshire N, Hamady M. Update: complications and management of infrarenal EVAR.  Eur J Radiol. 2008;  , July 8 (Epub ahead of print)
    PubMedSearch in Google Scholar
  • 4 Golzarian J, Struyven J. Imaging of complications after endoluminal treatment of abdominal aortic aneurysms.  Eur Radiol. 2001;  11 2244-2251
    CrossrefPubMedSearch in Google Scholar
  • 5 Wald R, Waikar S S, Liangos O, Pereira B J, Chertow G M, Jaber B L. Acute renal failure after endovascular vs open repair of abdominal aortic aneurysm.  J Vasc Surg. 2006;  43 460-466
    CrossrefPubMedSearch in Google Scholar
  • 6 Gahlen J, Hansmann J, Schumacher H, Seelos R, Richter G M, Allenberg J R. Carbon dioxide digital subtraction angiography for endovascular grafting in high-risk patients with infrarenal abdominal aortic aneurysms.  J Vasc Surg. 2001;  33 646-649
    CrossrefPubMedSearch in Google Scholar
  • 7 Chao A, Major K, Kumar S R et al.. Carbon dioxide digital subtraction angiography-assisted endovascular aortic aneurysm repair in the azotemic patient.  J Vasc Surg. 2007;  45 451-458
    CrossrefPubMedSearch in Google Scholar
  • 8 Criado E, Kabbani L, Cho K. Catheter-less angiography for endovascular aortic aneurysm repair: a new application of carbon dioxide as a contrast agent.  J Vasc Surg. 2008;  48 527-534
    CrossrefPubMedSearch in Google Scholar
  • 9 Becquemin J P, Majewski M, Fermani N et al.. Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair.  J Vasc Surg. 2008;  47 258-263
    CrossrefPubMedSearch in Google Scholar
  • 10 Perry R J, Martin M J, Eckert M J, Sohn V Y, Steele S R. Colonic ischemia complicating open versus endovascular abdominal aortic aneurysm repair.  J Vasc Surg. 2008;  48 272-277
    CrossrefPubMedSearch in Google Scholar
  • 11 Zhang W W, Kulaylat M N, Anain P M et al.. Embolization as cause of bowel ischemia after endovascular abdominal aortic aneurysm repair.  J Vasc Surg. 2004;  40 867-872
    CrossrefPubMedSearch in Google Scholar
  • 12 Berg P, Kaufmann D, van Marrewijk C J, Buth J. Spinal cord ischaemia after stent-graft treatment for infra-renal abdominal aortic aneurysms. Analysis of the Eurostar database.  Eur J Vasc Endovasc Surg. 2001;  22 342-347
    CrossrefPubMedSearch in Google Scholar
  • 13 Fortes D L, Atkins B Z, Chiou A C. Delayed paraplegia following intrarenal abdominal aortic endograft placement: case report and literature review.  Vascular. 2004;  12 130-135
    CrossrefPubMedSearch in Google Scholar
  • 14 Reid J A, Mole D J, Johnston L C, Lee B. Delayed paraplegia after endovascular repair of abdominal aortic aneurysm.  J Vasc Surg. 2003;  37 1322-1323
    CrossrefPubMedSearch in Google Scholar
  • 15 Garcia N D, Tehrani H, Morasch M, Pearce W, Matsumura J. Spinal cord ischemia following endovascular repair of an infrarenal aortic aneurysm.  Ann Vasc Surg. 2002;  16 509-512
    CrossrefPubMedSearch in Google Scholar
  • 16 Rockman C B, Riles T S, Landis R. Lower extremity paraparesis or paraplegia subsequent to endovascular management of abdominal aortic aneurysms.  J Vasc Surg. 2001;  33 178-180
    CrossrefPubMedSearch in Google Scholar
  • 17 Bajwa A, Davis M, Moawad M, Taylor P R. Paraplegia following elective endovascular repair of abdominal aortic aneurysm: reversal with cerebrospinal fluid drainage.  Eur J Vasc Endovasc Surg. 2008;  35 46-48
    CrossrefPubMedSearch in Google Scholar
  • 18 Kalliafas S, Albertini J N, Macierewicz J et al.. Incidence and treatment of intraoperative technical problems during endovascular repair of complex abdominal aortic aneurysms.  J Vasc Surg. 2000;  31 1185-1192
    CrossrefPubMedSearch in Google Scholar
  • 19 Görich J, Krämer S, Rilinger N et al.. Malpositioned or dislocated aortic endoprostheses: repositioning using percutaneous pull-down maneuvers.  J Endovasc Ther. 2000;  7 123-131
    CrossrefPubMedSearch in Google Scholar
  • 20 van Dijk L C, van Sambeek M R, Cademartiri F, Pattynama P M. Partial blockage of the renal artery ostium after stent-graft placement: detection and treatment.  J Endovasc Ther. 2003;  10 684
    CrossrefPubMedSearch in Google Scholar
  • 21 Fairman R M, Baum R A, Carpenter J P et al.. The Phase II EVT Investigators. . Limb interventions in patients undergoing treatment with an unsupported bifurcated aortic endograft system: a review of the Phase II EVT Trial.  J Vasc Surg. 2002;  36 118-126
    PubMedSearch in Google Scholar
  • 22 Amesur N B, Zajko A B, Orons P D, Makaroun M S. Endovascular treatment of iliac limb stenoses or occlusions in 31 patients treated with the Ancure graft.  J Vasc Interv Radiol. 2000;  11 421-428
    PubMedSearch in Google Scholar
  • 23 Maleux G, Koolen M, Heye S, Nevelsteen A. Limb occlusion after endovascular repair of abdominal aortic aneurysms with supported endografts.  J Vasc Interv Radiol. 2008;  19 1409-1412
    CrossrefPubMedSearch in Google Scholar
  • 24 Maldonado T S, Rockman C B, Riles E et al.. Ischemic complications after endovascular abdominal aortic aneurysm repair.  J Vasc Surg. 2004;  40 703-710
    CrossrefPubMedSearch in Google Scholar
  • 25 Carroccio A, Faries P L, Morrissey N J et al.. Predicting iliac limb occlusions after bifurcated aortic stent grafting: anatomic and device-related causes.  J Vasc Surg. 2002;  36 679-684
    CrossrefPubMedSearch in Google Scholar
  • 26 Maleux G, Koolen M, Heye S, Heremans B, Nevelsteen A. Mural thrombotic deposits in abdominal aortic endografts are common and do not require additional treatment at short-term and midterm follow-up.  J Vasc Interv Radiol. 2008;  19 1558-1562
    CrossrefPubMedSearch in Google Scholar
  • 27 Sharif M A, Lee B, Lau B B et al.. Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair.  J Vasc Surg. 2007;  46 442-448
    CrossrefPubMedSearch in Google Scholar
  • 28 van den Berg H R, Leijdekkers V J, Vahl A. Aortic stent-graft infection following septic complications of a kidney stone.  Cardiovasc Intervent Radiol. 2006;  29 443-445
    CrossrefPubMedSearch in Google Scholar
  • 29 Saratzis N, Saratzis A, Melas N, Ktenidis K, Kiskinis D. Aortoduodenal fistulas after endovascular stent-graft repair of abdominal aortic aneurysm: single-center experience and review of the literature.  J Endovasc Ther. 2008;  15 441-448
    CrossrefPubMedSearch in Google Scholar
  • 30 Bergqvist D, Björck M, Nyman R. Secondary aortoenteric fistula after endovascular aortic interventions: a systematic literature review.  J Vasc Interv Radiol. 2008;  19 163-165
    CrossrefPubMedSearch in Google Scholar
  • 31 Parra J R, Lee C, Hodgson K J, Perler B. Endograft infection leading to rupture of aortic aneurysm.  J Vasc Surg. 2004;  39 676-679
    CrossrefPubMedSearch in Google Scholar
  • 32 Baker M, Uflacker R, Robison J G. Stent graft infection after abdominal aortic aneurysm repair: a case report.  J Vasc Surg. 2002;  36 180-183
    CrossrefPubMedSearch in Google Scholar
  • 33 Mita T, Arita T, Matsunaga N et al.. Complications of endovascular repair for thoracic and abdominal aortic aneurysm: an imaging spectrum.  Radiographics. 2000;  20 1263-1278
    PubMedSearch in Google Scholar
  • 34 Orton D F, LeVeen R F, Saigh J A et al.. Aortic prosthetic graft infections: radiologic manifestations and implications for management.  Radiographics. 2000;  20 977-993
    PubMedSearch in Google Scholar

Geert MaleuxM.D. Ph.D. 

Department of Radiology, University Hospitals Leuven

Herestraat 49, B-3000 Leuven, Belgium

Email: geert.maleux@uz.kuleuven.ac.be