Early complications in endovascular treatment of abdominal aortic aneurysm

Objective : 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. Methods : 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. Results : 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%. Conclusions : 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.