Limb occlusion after endovascular repair of abdominal aortic aneurysms with supported endografts

To assess the time period of onset, etiology, and outcomes of limb occlusion after endovascular repair of abdominal aortic aneurysms with supported endografts.

From 1998 to 2007, 288 patients underwent endovascular aneurysm repair (EVAR) to exclude an infrarenal aortic aneurysm. In the majority of patients, a Zenith stent-graft (n = 187) or Excluder stent-graft (n = 71) was implanted. Nine patients presented with limb occlusion during follow-up. All occluded stent-grafts were modular (n = 8) or aortomonoiliac (n = 1) Zenith endoprostheses. One additional patient who was previously treated with a Zenith aortomonoiliac stent-graft was referred to our institution for further treatment of stent-graft thrombosis.

The initial clinical presentations were acute ischemia (n = 5), buttock claudication (n = 3), and incidental findings on follow-up imaging (n = 2). Occlusion occurred within the first month after EVAR (n = 5), between the first and second month after EVAR (n = 2), 10 months after EVAR (n = 1), and 4-5 years after EVAR (n = 2). Underlying causes of occlusion were kinking of the stent-graft (n = 5), small-diameter endograft limb with extension to the external iliac artery (n = 3), and migration and dislocation of an endograft limb (n = 2). Treatment consisted of catheter-directed thrombolysis and stent placement (n = 3), surgical thrombectomy or bypass operation (n = 5), and expectant management (n = 2). Outcome of all revascularization procedures showed immediate clinical success in all patients and no late recurrent limb ischemia at a mean follow-up of 38.9 months.

Limb occlusion of aortic stent-grafts mostly occurs shortly after EVAR and can be related to underlying kinking of the metallic skeleton, extension of the stent-graft into the external iliac artery, or migration and dislocation of an endograft limb. Satisfactory and durable clinical outcomes can be obtained after appropriate revascularization.