Complications in the endovascular repair of abdominal aortic aneurysms: a risk factor analysis

Objectives: to identify risk factors for complications following endovascul ar repair of abdominal aortic aneurysms (AAAs). Materials and methods: endovascular AAA exclusion was attempted in 64 patie nts. Patient characteristics, anatomic features of the aneurysm, operative technical aspects, and the experience of the teams were correlated with mor tality, occurrence of endoleak, and other complications. Perioperative comp lications were graded following the recommendations of the Ad Hoc Committee on reporting standards. For the assessment of correlation between risk fac tors and outcomes a logistic regression analysis was used. Results: complications were observed in 43% of the procedures and were clas sified as mild (24%), moderate (55%) or severe (21%). American Society of A naesthesiology (ASA) risk class 3 or 4, and advanced age were independent r isk factors for perioperative death and complications. Adjuvant procedures or overstenting of the renal arteries with the uncovered part of the stent were not associated with increased risk of complications. Nevertheless, in four of 24 overstented renal orifices, a renal infarction or ischaemia of t he kidney was observed on a postoperative CT scan. Advanced experience was associated with less complications, less endoleaks, and shorter operating t ime. Conclusions: high age and medical co-morbidity were associated with increas ed risk for perioperative complications and death. Additional perioperative procedures are usually well tolerated. With greater experience in endovasc ular AAA grafting the incidence of complications and endoleaks decreased.