TECHNICAL COMPLICATIONS OF ENDOVASCULAR ABDOMINAL AORTIC-ANEURYSM REPAIR

Purpose: Results from 34 endovascular repairs of abdominal aortic aneu rysms are reviewed to identify technical complications and relate them to anatomic and technical features of the operation. Methods: Twenty- one patients underwent attempted tube graft repair (mean follow-up, 13 months). Thirteen patients underwent placement of a bifurcated graft (mean follow-up, 7.2 months). Results: Twenty-five patients (74%) unde rwent repair without-technical complication (16 tube graft and nine bi furcated graft). Of five patients who had tube graft complications, tw o involved small iliac arteries and resulted in arterial injury, One o f these patients needed a femorofemoral bypass procedure, and the othe r required conversion to standard operation, Two patients had distal l eaks associated with the attachment system, and one patient had mispla cement of the distal attachment system. The two patients who had leaks were followed-up; one required operation after 7 months, whereas the other leak sealed. The patient who had distal attachment system mispla cement had a second endograft-placed within the first to provide a dis tal seal. The four patients who had bifurcated graft complications inv olved two graft limb stenoses, one managed with a Palmaz stent and the other with balloon angioplasty, The patient treated with balloon angi oplasty had graft thrombosis 1 week after the operation, which resulte d in the need for a femorofemoral bypass procedure. Another bifurcated graft patient had a graft limb twist, which has resulted in chronic c laudication. One patient had placement of a limb too proximal hi the c ommon iliac artery with chronic leak, and an open operation was perfor med IS months later, Conclusions: Technical complications in this seri es seem to be associated with short distal necks, small iliac arteries , tortuous iliac arteries, and atherosclerosis at the aortic bifurcati on. We believe that experience and understanding of these issues will reduce the risk. of these complications in the future.