Complications after endovascular aneurysm repair

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; complication; prostheses; stents.

Figure 1

Computed tomography scan 1 week after stent grafting shows large pseudoaneurysm in the right groin (asterisk).

Figure 2

Completion angiography (A) after implantation of a fenestrated stent graft (Zenith; Cook Medical). No kinking or residual stenosis was noted. One week later, the patient presented with acute left lower-limb ischemia. Angiography by brachial approach (B) confirmed left limb occlusion associated with important kinking of the left stent-graft limb (arrow). After 24 hours of in situ thrombolysis, the left limb was declotted (C). Note the residual stenosis (arrow) owing to limb kinking between two Z-stents. An additional self-expanding stent (Wallstent, Boston Scientific) (arrowheads) was placed to treat the kinking (D, E). Control computed tomography scan 2 years after successful thrombolysis shows a normally patent left stent-graft limb with additional Wallstent (F).

Figure 3

Computed tomography scan with axial (A) and sagittal (B) reconstruction 2 years after Zenith stent-graft implantation demonstrating semicircular mural deposits (arrows) within the body of the endoprosthesis. The patient is completely asymptomatic.

Figure 4

Computed tomography scan showing abdominal aortic aneurysm excluded by the stent graft, with axial (A) and coronal (B) reconstructions, 1 month after stent grafting, in a patient presenting with fever, general malaise, and back pain. The rim of the aneurysmal sac (arrowheads) is contrast enhanced, suggesting sac infection.

Figure 5

Another radiological presentation of aneurysmal sac infection: air bubbles (arrow) in the aneurysmal sac, close to the adjacent duodenum.

Figure 6

Computed tomography–guided (X-per CT, Philips, Best, The Netherlands) puncture (arrows) of the infected and excluded aneurysmal sac confirms Escherichia coli contamination of the clot. Note also the air bubbles within the clot (arrowheads).