Frequency, Predictive Factors, and Consequences of Stent-Graft Kink Following Endovascular AAA Repair

Presentation and management of delayed aortic endograft infection

A man in his 60s who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm 4 years ago presents with 1 week of abdominal pain, fever and leucocytosis. CT angiogram demonstrated an enlarged aneurysm sac with intraluminal gas and periaortic stranding consistent with infected EVAR. He was clinically unfit for an open surgical intervention due to his significant cardiac comorbidities, including hypertension, dyslipidaemia, type 2 diabetes, recent coronary artery bypass grafting and congestive heart failure secondary to ischaemic cardiomyopathy with an ejection fraction of 30%. Therefore, due to this significant surgical risk, he was treated with percutaneous drainage for the aortic collection and lifelong antibiotics. The patient is well 8 months following presentation with no signs of ongoing endograft infection, residual aneurysm sac enlargement, endoleak or haemodynamic instability.

Essentials of endovascular abdominal aortic aneurysm repair imaging: postprocedure surveillance and complications

OBJECTIVE

Lifelong postprocedural imaging surveillance is necessary after endovascular abdominal aortic aneurysm repair (EVAR) to assess for complications of endograft placement, as well as device failure and continued aneurysm growth. Refinement of the surveillance CT technique and development of ultrasound and MRI protocols are important to limit radiation exposure.

CONCLUSION

A comprehensive understanding of EVAR surveillance is necessary to identify life-threatening complications and to aid in secondary treatment planning.

Imaging Techniques for Detection and Management of Endoleaks after Endovascular Aortic Aneurysm Repair1

Endovascular aortic aneurysm repair (EVAR) is evolving into a viable alternative to open surgical repair for many patients with abdominal and thoracic aortic aneurysms. Endoleak development is a complication of EVAR and represents one of the limitations of this procedure. Endoleaks represent blood flow outside the stent-graft lumen but within the aneurysm sac. Lifelong imaging surveillance of patients after EVAR is critical to detect endoleaks for the patient's benefit and to determine the long-term performance of the stent-graft. Although computed tomographic angiography is the most commonly used examination for imaging surveillance, magnetic resonance angiography, ultrasonography, and digital subtraction angiography all have a role in endoleak detection and management. This review will focus on imaging techniques used for endoleak detection and the role imaging surveillance plays in the overall care of the post-EVAR patient.

Delayed Complications Following EVAR

More than a decade after the first clinical attempts, two large randomized studies have proven that endovascular aortic aneurysm repair (EVAR) provides immediate advantages over open repair. In the long run, however, a relatively high number of reinterventions is necessary to improve the long-term efficacy of EVAR, which may outweigh the early benefits. Since EVAR is gaining popularity in the medical community and in patients with abdominal aortic aneurysm (AAA), it is expected that a growing number of patients will present with delayed complications requiring some kind of reinterventions. For the patient's safety, vascular surgeons and interventional radiologists involved in EVAR must be well aware of these complications and the ways to overcome them. We began our endovascular program for AAA in 1994 and currently follow 485 patients with a variety of manufactured grafts. In this article we describe the delayed complications observed with EVAR, their mechanisms, favoring factors, and ways to treat them.