Endovascular treatment of late complications of open surgical repair in abdominal aortic and iliac segment

Abstract

Introduction. Promising results of endovascular abdominal aortic aneurysm treatment prompts one to consider applying the method in order to manage complications following the previous open procedures in the aorto-iliac segment. The study aimed at assessing the technical feasibility of applying endovascular methods to manage complications in this group. Material and methods. From December 2009 to August 2018, 26 patients (24 males, 2 females) with a mean age of 72 years, underwent endovascular procedures as reinterventions to manage paraanastomotic aneurysms and new true aneurysms in aorto-iliac segment. Twenty one bifurcated, two branched devices and five tube stent-grafts have been implanted. Results. One immediate open conversion was performed. Eventually, in all of the analysed cases, perianastomotic pseudoaneurysms and true aneurysms were successfully managed. Two cases of type I endoleaks were noticed and managed intraoperatively. No deaths occurred in the perioperative period. In six patients, there were early local complications and early general complications were reported in eight patients. The average length of hospital stay was seven days. Patients have been followed up for 6 to 90 months. No endoleaks nor stent-graft migrations have been reported. Five deaths have been noted not connected with the secondary intervention. Sixteen patients remain in follow-up. Conclusions. Endovascular perianastomotic aneurysm treatment is technically feasible and associated with a low risk of perioperative complications, and a high surgical efficacy. When planning the reintervention, one should take into account the altered anatomy of the aorto-iliac segment. Familiarity with the equipment and experience in the endovascular techniques is of crucial significance.