Decreased Ischemic Complications After Endovascular Aortic Aneurysm Repair With Newer Devices

Abstract

Ischemic complications after endovascular abdominal aortic aneurysm repair (EVAR) are well-recognized and have been reported to be as high as 9%. The goal of our study was to examine the incidence, management, and outcome of ischemic complications at our institution after EVAR and to compare complications according to graft type and time period. This is a retrospective review of all EVARs performed at our institution from 1993 through 2005 (n = 430). EVAR was performed in asymptomatic patients in most cases. Follow-up consisted of a computed tomography scan and office visit at 1, 6, and 12 months and yearly thereafter. Ischemic complications after EVAR have decreased significantly with the advent of lower-profile devices with easier delivery systems and supported limbs. Simultaneous coil embolization of internal iliac artery at the time of EVAR implant does not appear to increase the risk of pelvic or lower-extremity ischemia, can be done safely, and does not need to be staged.

Women derive less benefit from elective endovascular aneurysm repair than men

“…More recent reports suggested that newer devices mitigated the risk. 20 It is difficult, therefore, to reconcile the increased incidence of colon ischemia in females undergoing elective EVAR, until one looks at the absolute numbers. In fact, only three out of 344 (0.9%) women required surgery for an ischemic colon after elective EVAR.…”

Implications of concomitant hypogastric artery embolization with endovascular repair of infrarenal abdominal aortic aneurysms

“…Some investigators have reported an increased risk of such complications, whereas others do not. [5][6][7] As a result, further data are needed on outcomes of EVAR with HAE. Continued advancement of endovascular techniques and endograft design has allowed preservation of hypogastric artery flow.…”

Successful stenting to superior mesenteric artery (SMA) after endovascular aneurysm repair (EVAR) of abdominal aorta

“…Fortunately, the Palmatz stent could be placed precisely at the origin of the SMA via this uncovered area of the stent graft. Ischemic complications after EVAR have decreased significantly with the advent of lower profile devices with easier delivery systems and supported limbs [9]. However, like this case with multiple vascular disease, we have to pay special attention for the placement of endograft in the procedure of EVAR to keep the branches' flow as much as possible.…”