Incidence and treatment of intraoperative technical problems during endovascular repair of complex abdominal aortic aneurysms

Abstract

Endovascular repair (EVR) of abdominal aortic aneurysm (AAA) is being performed with increasing frequency worldwide. Reports about technical feasibility 1 and results in selected series of patients have been reported in the literature. 2,3 Increased technical expertise and improved graft design have expanded the applications of this technique, and currently more difficult aneurysms are treated by the endovascular approach. Technical complications in selected group of patients have been reported by several authors. [4][5][6] However, intraoperative technical problems are expected to increase when complex aneurysms are treated.

Methods for Three-Dimensional Geometric Characterization of the Arterial Vasculature

“…Specifically, arterial tortuosity and branching frequently pose problems for endovascular sheath navigation, device deployment, and successful minimally invasive treatment of a particular vascular pathology. In the case of elective endovascular aneurysm repair (EVAR) alone, adverse anatomic features such as tortuosity at proximal neck and iliac fixation sites affect endograft placement and have been associated with the occurrence of endograft migration and endoleak 10,28,46 or iliac limb kinking resulting in graft thrombosis. 28,34,51,52 Difficulties in endograft sizing for complex and tortuous aneurysm morphologies often leads to the secondary placement of costly modular extensions in the common iliac arteries 56,60 or conversely inadvertent side branch occlusion, 28,29 factors which could adversely affect technical success of a procedure.…”

Duplex ultrasound imaging to detect limb stenosis or kinking of endovascular device

“…[1][2][3][4][5][6] After limb thrombosis, additional interventions may be required, which include but are not limited to endovascular and open surgical revascularization. [7][8][9] Predisposing factors that may contribute to graft limb thrombosis include areas of stenosis and kinking, such as the aortic bifurcation and within the iliac arteries, 3,10,11 unsupported endograft devices, 2 nonuniformity of the endograft lumen from device overlap, 12 and changes in static and dynamic forces exerted on the endograft itself. 13,14 Most EVAR surveillance today is done primarily with serial computed tomography angiography (CTA) or multimodality imaging, such as a combination of CT scans and duplex ultrasound (DU) imaging.…”

Anatomic severity grading score predicts technical difficulty, early outcomes, and hospital resource utilization of endovascular aortic aneurysm repair

“…[14][15][16] The ability to handle intraoperative difficulties by additional endovascular means also continues to improve. We were able to demonstrate an overall adjunctive rate of 67% and an endovascular access site management rate of 75%.…”