Treatment of Complications Following Endovascular Repair of Abdominal Aortic Aneurysms

ABSTRACT

Endovascular aneurysm repair (EVAR) is an important treatment option for abdominal aortic aneurysms, with lower perioperative morbidity and mortality rates than open surgical aneurysm repair. However, EVAR is associated with several unique complications that are not encountered with surgical repair such as endoleaks, graft migration, and renal artery occlusion. Preservation of the morbidity and mortality advantages of EVAR relies on the successful treatment of these complications by minimally invasive, endovascular approaches. Some of the techniques used to treat EVAR complications include balloon dilation and stenting, deployment of additional stent-graft pieces, coil embolization, and thrombolysis. Although the employment of these endovascular salvage techniques is common, data regarding their intermediate- to long-term efficacy is sparse, and further studies are needed to determine their efficacy in preventing conversion to open aneurysm repair and aneurysm rupture.

Endovascular repair - aortic aneurysm - stent graft - endoleak

REFERENCES

• 1 Parodi J C, Palmaz J C, Barone H D. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms.  Ann Vasc Surg. 1991;  5 491-499
• 2 Prinssen M, Verhoeven E LG, Buth J et al.. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms.  N Engl J Med. 2004;  351 1607-1618
• 3 Greenhalgh R M, Brown L C, Kwong G P, Powell J T, Thompson S G. EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day mortality results: randomized controlled trial.  Lancet. 2004;  364 843-848
• 4 Harris P L, Vallabhaneni S R, Desgranges P, Becquemin J P, Marrewijk C, Laheij R JF. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience.  J Vasc Surg. 2000;  32 739-749
• 5 Vallabhaneni S R, Harris P L. Lessons learnt from the EUROSTAR registry on endovascular repair of abdominal aortic aneurysm repair.  Eur J Radiol. 2001;  39 34-41
• 6 Cao P, Verzini F, Parlani G et al.. Clinical effect of abdominal aortic aneurysm endografting: 7-year concurrent comparison with open repair.  J Vasc Surg. 2004;  40 841-848
• 7 Hausegger K A, Schedlbauer P, Deutschmann H A, Tiesenhausen K. Complications in endoluminal repair of abdominal aortic aneurysms.  Eur J Radiol. 2001;  39 22-33
• 8 Brewster D C, Cronenwett J L, Hallett J W, Johnston K W, Krupski W C, Matsumura J S. Guidelines for the treatment of abdominal aortic aneurysms.  J Vasc Surg. 2003;  37 1106-1117
• 9 Sampram E SK, Karafa M T, Mascha E J et al.. Nature, frequency, and predictors of secondary procedures after endovascular repair of abdominal aortic aneurysm.  J Vasc Surg. 2003;  37 930-937
• 10 Becquemin J P, Kelley L, Zubilewicz T, Desgranges P, Lapeyre M, Kobeiter H. Outcomes of secondary interventions after abdominal aortic aneurysm endovascular repair.  J Vasc Surg. 2004;  39 298-305
• 11 Terramani T T, Chaikof E L, Rayan S S et al.. Secondary conversion due to failed endovascular abdominal aortic aneurysm repair.  J Vasc Surg. 2003;  38 473-478
• 12 Laheij R JF, Buth J, Harris P L, Moll F J, Stelter W J, Verhoeven E LG. Need for secondary interventions after endovascular repair of abdominal aortic aneurysms. Intermediate-term follow-up results of a European collaborative registry (Eurostar).  Br J Surg. 2000;  87 1666-1673
• 13 Chaikof E L, Blankensteijn J D, Harris P L et al.. Reporting standards for endovascular aortic aneurysm repair.  J Vasc Surg. 2002;  35 1048-1060
• 14 Hayoz D, Do D D, Mahler F, Triller J, Spertini F. Acute inflammatory reaction associated with endoluminal bypass grafting.  J Endovasc Surg. 1997;  4 354-360
• 15 Velazquez O C, Carpenter J P, Baum R A et al.. Perigraft air, fever, and leukocytosis after endovascular repair of abdominal aortic aneurysms.  Am J Surg. 1999;  178 185-189
• 16 Walker S R, Yusuf S W, Wenham P W, Hopkinson B R. Renal complications following endovascular repair of abdominal aortic aneurysms.  J Endovasc Surg. 1998;  5 318-322
• 17 Bown M J, Fishwick G, Sayers R D. The post-operative complications of endovascular aortic aneurysm repair.  J Cardiovasc Surg (Torino). 2004;  45 335-347
• 18 Conners M S, Sternberg W C, Carter G, Tonnessen B H, Yoselevitz M, Money S R. Endograft migration one to four years after endovascular abdominal aortic aneurysm repair with the AneuRx device: a cautionary note.  J Vasc Surg. 2002;  36 476-484
• 19 Cao P, Verzini F, Zannetti S et al.. Device migration after endoluminal abdominal aortic aneurysm repair: analysis of 113 cases with a minimum follow-up period of 2 years.  J Vasc Surg. 2002;  35 229-235
• 20 England A, Butterfield J S, Jones N et al.. Device migration after endovascular abdominal aortic aneurysm repair: experience with a Talent stent-graft.  J Vasc Interv Radiol. 2004;  15 1399-1405
• 21 Hinchliffe R J, Hopkinson B R. Endovascular repair of abdominal aortic aneurysm: current status.  J R Coll Surg Edinb. 2002;  47 523-527
• 22 Tonnessen B H, Sternbergh W C, Money S R. Late problems at the proximal neck: migration and dilation.  Semin Vasc Surg. 2004;  17 288-293
• 23 May J, White G H, Waugh R et al.. Life-table analysis of primary and assisted success following endoluminal repair of abdominal aortic aneurysms: the role of supplementary endovascular intervention in improving outcome.  Eur J Vasc Endovasc Surg. 2000;  19 648-655
• 24 Faries P L, Cadot H, Agarwal G, Kent K C, Hollier L H, Marin M L. Management of endoleak after endovascular aneurysm repair: cuffs, coils, and conversion.  J Vasc Surg. 2003;  37 1155-1161
• 25 Sanchez L A, Farber M A, Rubin B G et al.. Proximal attachment failure of AneuRx grafts: is there a role for Talent Aortic Cuffs? [abstract]. Available at: http://scvs.vascularweb.org/SCVS_Contribution_Pages/Abstracts/2005/SCVS05_Abstract05.html Accessed May 9, 2005
• 26 Wolf Y G, Bradley B, Fogarty T J, Cipriano P R, Zarins C K. Late endoleak after endovascular repair of an abdominal aortic aneurysm with multiple proximal extender cuffs.  J Vasc Surg. 2002;  35 580-583
• 27 Stavropoulos S W, Baum R A. Imaging modalities for the detection and management of endoleaks.  Semin Vasc Surg. 2004;  17 154-160
• 28 Stavropoulos S W, Clark T WI, Carpenter J P et al.. Use of CT angiography to classify endoleaks after endovascular repair of abdominal aortic aneurysms.  J Vasc Interv Radiol. 2005;  16 663-667
• 29 Baum R A, Carpenter J P, Tuite C M et al.. Diagnosis and treatment of inferior mesenteric arterial endoleaks after endovascular repair of abdominal aortic aneurysms.  Radiology. 2000;  215 409-413
• 30 Hinchliffe R J, Singh-Ranger R, Davidson I R, Hopkinson B R. Rupture of an abdominal aortic aneurysm secondary to type II endoleak.  Eur J Vasc Endovasc Surg. 2001;  22 563-565
• 31 Fisher R K, Brennan J A, Gilling-Smith G L, Harris P A. Continued sac expansion in the absence of a demonstrable endoleak is an indication for secondary intervention.  Eur J Vasc Endovasc Surg. 2000;  20 96-98
• 32 Tzortzis E, Hinchliffe R J, Hopkinson B R. Adjunctive procedures for the treatment of proximal type I endoleak: the role of peri-aortic ligatures and Palmaz stenting.  J Endovasc Ther. 2003;  10 233-239
• 33 Ohki T, Veith F J, Shaw P et al.. Increasing incidence of midterm and long-term complications after endovascular graft repair of abdominal aortic aneurysms: a note of caution based on a 9-year experience.  Ann Surg. 2001;  234 323-335
• 34 Sheehan M K, Barbato J, Compton C N, Zajko A, Rhee R, Makaroun M S. Effectiveness of coiling in the treatment of endoleaks after endovascular therapy.  J Vasc Surg. 2004;  40 430-434
• 35 White G H, May J, Waugh R C, Caufour X, Yu W. Type III and type IV endoleak: toward a complete definition of blood flow in the sac after endoluminal repair.  J Endovasc Surg. 1998;  5 305-309
• 36 White G H, May J, Waugh R C, Yu W. Type I and type II endoleaks: a more useful classification for reporting results of endoluminal AAA repair.  J Endovasc Surg. 1998;  5 189-193
• 37 Baum R A, Carpenter J P, Golden M A et al.. Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms: comparison of transarterial and translumbar techniques.  J Vasc Surg. 2002;  35 23-29
• 38 Gorich J, Rilinger N, Sokiranski R et al.. Treatment of leaks after endovascular repair of aortic aneurysms.  Radiology. 2000;  215 414-420
• 39 Baum R A, Cope C, Fairman R, Carpenter J P. Translumbar embolization of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms.  J Vasc Interv Radiol. 2001;  12 111-116
• 40 van den Berg J C, Nolthenius R P, Casparie J W, Moll F L. CT-guided thrombin injection into aneurysm sac in a patient with endoleak after endovascular abdominal aortic aneurysm repair.  AJR Am J Roentgenol. 2000;  175 1649-1651
• 41 Stavropoulos S W, Carpenter J P, Fairman R M, Golden M A, Baum R A. IVC transversal for translumbar endoleak treatment after endovascular AAA repair.  J Vasc Interv Radiol. 2003;  14 1191-1194
• 42 Wisselink W, Cuesta M A, Berends F J, van den Berg F G, Rauwerda J A. Retroperitoneal endoscopic ligation of lumbar and inferior mesenteric arteries as a treatment of persistent endoleak after endoluminal aortic aneurysm repair.  J Vasc Surg. 2000;  31 1240-1244
• 43 Fairman R M, Baum R A, Carpenter J C, Deaton D H, Makaroun M S, Velazquez O C. Limb interventions in patients undergoing treatment with an unsupported bifurcated aortic endograft system: a review of the phase II EVT trial.  J Vasc Surg. 2002;  36 118-126
• 44 Carpenter J P, Neshis D G, Fairman R M et al.. Failure of endovascular abdominal aortic aneurysm graft limbs.  J Vasc Surg. 2001;  33 296-303
• 45 Amesur N B, Zajko A B, Orons P D, Makaroun M S. Endovascular treatment of iliac limb stenoses or occlusions in 31 patients treated with the Ancure endograft.  J Vasc Interv Radiol. 2000;  11 421-428
• 46 Amesur N B, Zajko A B, Makaroun M S. Treatment of a failed bifurcated abdominal aortic stent graft with thrombolysis and wallstent placement.  J Vasc Interv Radiol. 1997;  8 795-798
• 47 Gorich J, Rilinger N, Soldner J et al.. Endovascular repair of aortic aneurysms: treatment of complications.  J Endovasc Surg. 1999;  6 136-146
• 48 Liewald F, Sharrer-Pamler R, Gorich J et al.. Intraoperative, perioperative, and late complications with endovascular therapy of aortic aneurysm.  Eur J Vasc Endovasc Surg. 2001;  22 251-256
• 49 Ruckert R I, Romaniuk P, Rogalla P, Umsheid T, Stelter W J, Muller J M. A method for adjusting a malpositioned bifurcated aortic endograft.  J Endovasc Surg. 1998;  5 261-265
• 50 Kopchok G, White R, Conayre C. Troubleshooting maldeployed aortic endografts.  J Endovasc Surg. 1998;  5 266-268