Endovascular repair of aortic aneurysms: Treatment of complications

Purpose:To evaluate the use of interventional procedures for treating compl ications following endovascular repair of aortic aneurysms. Methods: Fifty-five patients (49 men; mean age 67.5 years) underwent endolu minal stent-graft repair of traumatic (n = 4) or arteriosclerotic (n = 51) aortic aneurysms in the thoracic (n = 3) or infrarenal (n = 52) aorta. Foll ow-up of therapeutic success included periodic clinical examination, angiog raphy, and spiral computed tomography. Results: Discounting the 25 (45%) cases of postimplantation syndrome that d id not require treatment, there were 22 complications observed in 20 (36%) patients over a mean 10-month follow-up (range 1 to 27). There were 2 trans renal endograft maldeployments, 1 case of twisted graft limbs, 2 access sit e problems (1 patient), 12 endoleaks (11 patients), 1 late graft limb throm bosis, 1 symptomatic internal iliac artery occlusion, 2 myocardial infarcti ons, and 1 transient psychosis. Seven (13%) patients did not undergo specif ic therapy, while 4 (7%) required operation (2 crossover bypass grafts, 1 s uture revision, and 1 graft replacement). Among 9 (16%) patients treated wi th interventional techniques, 7 underwent percutaneous coil embolization fo r 8 endoleaks (7 successfully resolved). One late stent-graft disconnection required an additional stent-graft, and 1 of the 2 malpositioned endograft s was repositioned. All patients remain alive with no increase in the diame ter of the aneurysm in any patient. Conclusions: Technical problems resulting from the endovascular repair of a ortic aneurysms often respond to interventional treatment.