Early complications in endovascular treatment of abdominal aortic aneurysm

The incidence of perioperative complications during endovascular repair of abdominal aortic aneurysm (EVAR) is reported in limited series. The aim of this study is to evaluate a multi-center survey of unexpected intraprocedural critical events of EVAR.

A questionnaire relative to intraprocedural complications during EVAR was sent to major vascular surgery divisions in Italy. Eleven answered to the survey. The data obtained are relative to 1696 procedures.

A wide range of incidence of critical events was observed, from a lower value of 2.7% to a higher value of 68.8% (mean 21.16%). The problems relative to the insertion phase of the delivery system were 7.7%. Endoleaks were reported in 5.5% of cases. Stent graft release was problematic in 0.4% of cases and in another 0.4% there was a problem in shaft retrieval. Unintentional coverage of renal or polar arteries occurred in 0.8% of the procedures ; hypogastric arteries were unwillingly excluded in 2.7% of cases. Aortic or iliac artery rupture had an incidence of 0.7% ; arterial dissection occurred in 0.9%, atheroembolism in 0.5%, lower limb ischemia due to graft limb kinks in 0.7% and to occlusion in 0.9%.

Perioperative critical events represent a serious problem only in few cases of EVAR ; they are common but in many cases not predictable ; in most circumstances they can be easily corrected with adjunctive manoeuvres during the same procedure. There is a highly significant correlation between the total workload and the incidence of critical events ; these do not appear to be related to the learning curve.