Complications of Endovascular Repair for Thoracic and Abdominal Aortic Aneurysm: An Imaging Spectrum

Abstract

Endovascular stent-graft implantation is an alternative to conventional open surgery for the treatment of aortic aneurysm. Forty-nine consecutive patients with aortic aneurysm (thoracic, n = 17; infrarenal, n = 32) were treated with endovascular stent-graft implantation. Complications occurred in 25 patients (two patients had two complications): endoleak (n = 13), graft thrombosis (n = 5), graft kinking (n = 2), pseudoaneurysm caused by graft infection (n = 1), graft occlusion (n = 1), shower embolism (n = 1), perforation of mural thrombus by means of inadvertent penetration of delivery system (n = 1), colon necrosis (n = 1), aortic dissection (n = 1), and hematoma at the arteriotomy site (n = 1). Imaging findings were analyzed for spiral computed tomography, plain abdominal radiography, transesophageal echocardiography, and digital subtraction angiography. Since some of these complications are fatal, radiologists need to instantly and accurately recognize them. Awareness and understanding of possible complications should help ensure a safe, successful procedure.

Identification of Predictive CT Angiographic Factors in the Development of High-Risk Type 2 Endoleaks after Endovascular Aneurysm Repair in Patients with Infrarenal Aortic Aneurysms

“…Systematic preoperative embolization of all aortic side branches in the region of the aneurysm reduces the number and size of type 2 endoleaks after EVAR [33,34]. On the other hand this means another intervention that is technically demanding, time-consuming, and has a certain risk of complications [35]. The non-critical implementation of preoperative embolization in the clinical routine is controversial due to the high rate of spontaneous thrombosis in type 2 endoleaks [36].…”

Development of a flexible pressure sensor for measurement of endotension

“…Complications specific to endovascular grafts (adapted from (Katzen et al 2006) Endoleak is a term that describes persistent aneurysm sac perfusion and pressurization (Katzen et al 2006). It is the most common complication after stent-graft implantation (Mita et al 2000) and occur mainly due to incomplete seal of the endovascular graft. Endoleaks have been categorized as follows in Table 2 and are treated by a variety of means, including conversion to surgical repair, or insertion of a new stent or graft.…”

Revisión pictográfica de endoleaks (endofugas)

“…El tratamiento de elección de los aneurismas aórticos es la instalación de una endoprótesis en el lumen aórtico por vía endovascular, logrando dirigir el flujo a través del aneurisma, previniendo el crecimiento y/o rotura de éste (1,2) . Las endoprótesis no están exentas de complicaciones.…”

“…Las endoprótesis no están exentas de complicaciones. Dentro de las más frecuentes podemos encontrar: endoleaks o endofugas (1)(2)(3)(4) , trombosis de la endoprótesis (2,4) , angulación de la endoprótesis (2) , migración de la endoprótesis desde el sitio de fijación (2,3) y formación de pseudoaneurismas secundarios a una lesión de la pared arterial (2,3) . Los endoleaks son la complicación más frecuente, con una frecuencia estimada entre 15 a 52% (5) , y de no ser detectados a tiempo, pueden progresar mediante el crecimiento y rotura del aneurisma.…”