Thromboembolic complications after endovascular aortic aneurysm repair

To evaluate the frequency and significance of thromboembolic complications following endovascular treatment of aortic aneurysms.

One hundred seventy-four patients (153 men; mean 71.4 years, range 26-90) underwent endovascular repair of aneurysms of the thoracic (n = 38) or abdominal (n = 136) aorta using a variety of endografts. All patients were examined preprocedurally using 3-phase helical computed tomography (CT) to determine appropriate endograft size. To exclude the occurrence of infarction in parenchymal organs, the first postprocedural CT scan was compared with preoperative findings. Newly recognized perfusion deficits were taken as evidence of procedure-related infarction.

Infarctions were detected in 16 (9.2%) patients: 13 in the kidneys, 2 in the spleen, with 1 in the mesentery; only the mesenteric infarction was clinically symptomatic. Both splenic infarctions were associated with deployment of stent-grafts in the thoracic aorta (5.3% of the 38 patients), while the mesenteric and 13 renal infarctions were seen in patients with infrarenal abdominal aortic aneurysms (0.7% and 9.6%, respectively, of 136 patients). One patient experienced complete thromboembolic occlusion of a renal artery, which was partially recanalized with intraoperative lysis.

Thromboembolic complications of endovascular aortic aneurysm repairs are not uncommon, and although usually asymptomatic, these sequelae have the potential to be life threatening. Perfusion abnormalities may respond to immediate lytic therapy with complete dissolution of the thrombus in certain isolated cases.