Ischemic complications after endovascular abdominal aortic aneurysm repair

Maldonado, Thomas S.; Rockman, Caron; Riles, Eric M.; Douglas, Diah; Adelman, Mark A.; Jacobowitz, Glenn R.; Gagne, Paul J.; Nalbandian, Matthew; Cayne, Neal S.; Lamparello, Patrick J.; Salzberg, Stephanie S.; Riles, Thomas S.

doi:10.1016/j.jvs.2004.07.032

Cited by 201 publications

(150 citation statements)

References 32 publications

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“…Remaining studies were observational studies of incidence, describing rates of IC specifically after emergency repair, or after aneurysm repair in general, , with no further identification of risk factors [34][35][36][37][38][39][40] .…”

Section: Operative Factorsmentioning

confidence: 99%

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

Lee

Daniels

Drake

et al. 2016

Int J Colorectal Dis

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Article:Lee, M.J. orcid.org/0000-0001-9971-1635, Daniels, S.L., Drake, T.M. et al.(1 more author) (2016) Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis. International Journal of Colorectal Disease, 31 (7). pp. 1273 -1281 . ISSN 0179-1958 https://doi.org/10.1007/s00384-016-2606-6 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request.

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Section: Operative Factorsmentioning

confidence: 99%

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

Lee

Daniels

Drake

et al. 2016

Int J Colorectal Dis

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“…Twisting of grafted limbs narrows the lumen and predisposes to thrombosis. It has been reported that a graft extending into the external iliac artery is a high risk factor for occlusion (16). When the graft extends into the external iliac artery, the likelihood of kinking is higher.…”

Section: Discussionmentioning

confidence: 99%

Limb graft occlusion following endovascular aortic repair: Incidence, causes, treatment and prevention in a study cohort

Wang

Zhai

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The present study investigated the incidence, causes, treatment and prevention of limb graft occlusion following endovascular aortic repair (EVAR). A total of 66 cases of abdominal aortic aneurysm receiving EVAR at our department from January 2005 to December 2013 were enrolled. After EVAR, patients received routine antiplatelet therapy of 75 mg PLAVIX for 6 months and then 100 mg Aspirin for another 6 months by oral administration. According to previous clinical experiences, antiplatelet therapy is able to effectively reduce the incidence of iliac occlusion after EVAR. A total of 61 bifurcated grafts and 5 aortauniilac grafts (127 limbs in total) were used. Physical examination, ankle-brachial-index and computer tomographic angiography were performed at 10 days, at 3, 6 and 12 months and annually thereafter. It was found that 7 limbs in 7 patients (10.6% of patients, 5.5% of limbs) were occluded between 20 days and 12 months (average, 7.8±5.3 months) after EVAR. Acute and severe ischemia was found in 2 cases, claudication was in found 3 cases, asthenia in both legs was found in 1 case and 1 case was asymptomatic. Femoral-femoral bypass, femoral-femoral bypass and stenting, aorto-iliac/femoral bypass, thrombectomy and conservative treatment were performed in 1 patient each and thrombectomy together with stenting was performed in 2 cases. Limb graft occlusion was not rare after EVAR. Treatment of this complication included surgery and endovascular therapy such as bypass, thrombectomy and thrombolysis. In conclusion, aggressive pre-emptive treatment including angioplasty and stenting prevented occlusion in certain cases.

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“…Small bowel ischaemia in non-complex, non-fenestrated infrarenal EVAR is very rare, whereas colonic ischaemia due to embolization to the inferior mesenteric artery occurs in 1.0-2.9% [4,10]. The occurrence of colonic ischaemia has also been found to be unrelated to the presence of preoperative hypogastric artery occlusion [4].…”

Section: Discussionmentioning

confidence: 99%

Causes and consequences of mesenteric embolization after endovascular aorto-iliac intervention — a nested case control study

Acosta

Kärkkäinen

2017

Anaesthesiol Intensive Ther

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Background: Causes and consequences of mesenteric embolization after endovascular aorto-iliac procedures have not been studied adequately. Methods: Consecutive patients with mesenteric embolization after endovascular aorto-iliac intervention between 2011 and 2015 (case-group, n = 9) were investigated and compared with age, gender and procedure-matched random controls (n = 36). Results: Compared to the control group, a higher proportion of patients with mesenteric embolization were current smokers (89% vs. 53%; P = 0.048) and had renal insufficiency at admission (44% vs. 11%; P = 0.019). In patients treated for aorto-iliac occlusive disease, aortic irregularity (shagginess) was more severe (P = 0.015), visceral thrombus volume was larger (P = 0.004) and operation-time was longer (P = 0.009) among the case-group. However, no differences were found between cases with mesenteric embolization caused by endovascular aortic aneurysm repair versus controls. Myoglobin, arterial blood lactate, aspartate aminotransferase, alanine aminotransferase and pancreatic amylase levels were elevated in 100%, 67%, 89%, 89%, 89% and 56% of patients with mesenteric embolization, respectively. Overall in-hospital mortality among cases was 33% (3/9). The in-hospital mortality was 17% (1/6) in patients treated with open abdomen therapy, of whom five were managed with stomas. Conclusion: Smoking cessation, careful patient selection and procedure planning with identification of severe shaggy aortas might prevent mesenteric embolization during aorto-iliac procedures. In suspected cases of mesenteric embolization, elevated myoglobin and arterial blood lactate may be indicative of this complication. Aspartate and alanine aminotranferases, as well as pancreatic amylase, are also relevant tests to assess the extent of organ ischaemia. Damage control with open abdomen therapy and the creation of stomas seem justifiable in order to improve survival in this complex situation.

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Ischemic complications after endovascular abdominal aortic aneurysm repair

Cited by 201 publications

References 32 publications

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

Limb graft occlusion following endovascular aortic repair: Incidence, causes, treatment and prevention in a study cohort

Causes and consequences of mesenteric embolization after endovascular aorto-iliac intervention — a nested case control study

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