Adjunctive Procedures for the Treatment of Proximal Type I Endoleak: The Role of Peri-Aortic Ligatures and Palmaz Stenting

Complications and Bail-Out Situations during AAA Endovascular Repair

The endovascular stent-graft is now a universally accepted treatment for abdominal aortic aneurysms but remains nonetheless experimental. There are generic aspects of endograft insertion as well as device specific deployment issues. There are a number of potential procedural complications, related to vascular access and to the deployment sequence. The common technical problems are described and, where possible, the endovascular solutions are outlined.

What is the significance of endoleaks and endotension

Endovascular repair has been used over a decade as a treatment of abdominal aortic aneurysm, and has become a widely accepted treatment method with a low rate of perioperative complications. Endoleak, perigraft blood flow outside endograft but within aneurysmsac, has been intensively studied during the last 10 years of endovascular aneurysm repair (EVR). The natural history of aneurysms with endoleak and the true clinical significance of various types of endoleaks remains unclear. Type I/III endoleak has been found to be associated with aneurysm rupture, while the risk of rupture of aneurysms with type II endoleak and endotension appears very small. In endotension, the aneurysm sac remains pressurized, even if there is no evidence of an endoleak. Currently,it is accepted that type I/III endoleaks should be corrected, preferably by endovascular means, due to the risk of rupture. If endovascular repair is not possible, then open conversion should be considered. The risk of conversion should be weighed against the risk of aneurysm rupture. Treatment of type II endoleaks and endotension is more controversial. In those with aneurysm enlargement,secondary interventions are often performed.