Complications - Abdominal Aortic Aneurysm - Endovascular Therapy

Primary access problems in the area of the femoral artery due to arteriosclerotic changes

• Prophylaxis: thorough clinical examination, if necessary preoperative angiographic clarification, intraoperative subtle preparation of the inguinal vessels
• Management: vascular surgical reconstruction (thromboendarterectomy, patch plasty, bypass or similar)

Dissection or rupture in the course of the iliac artery or aorta due to endovascular materials (wires, catheters, sheaths, endoprosthesis)

• Prophylaxis: Manipulations only under X-ray control
• Management: Final check of arterial inflow and radiological control, leave guidewire in-situ for further interventions, vascular surgical reconstruction after extraperitoneal or transperitoneal exposure

Peripheral Embolism

• Prophylaxis: controlled manipulation, perioperative heparin administration
• Management: radiological or vascular surgical intervention

Handling errors during implantation of the endoprosthesis

• Prophylaxis: Theoretical and practical exercises regarding the characteristics of the individual products (markings, release mechanism etc.)
• Management: Interventional correction, conversion

Wound healing disorders in the groins or lymph fistula

• Prophylaxis: Preparation technique, perioperative single-shot antibiotic
• Management: usually conservative, swab collection for microbiological examination, depending on antibiotic therapy, in case of persistence possibly wound revision

Renal insufficiency

• Prophylaxis: Limitation of intraoperative contrast agent administration, administration of acetylcysteine
• Management: Exclusion of renal hypoperfusion by duplex sonography, high infusion rates, additionally possibly diuretic administration, nephrological consultation

Prosthesis limb occlusion

• Prophylaxis: Planning, diagnosis and therapy for AVK, prosthesis selection
• Management: interventional correction, femoro-femoral bypass system

Endoleaks (Refilling of the aneurysm sac)

• Prophylaxis: Correct planning and measurement of the endoprosthesis, if necessary primary interventional closure of large-caliber side branches (Coiling)
• Management:
  for Type I (from proximal or distal) early angiographic representation and reintervention using stent extension,
  for Type II (retrograde via lumbar arteries or inferior mesenteric artery) initially conservative, angiographic representation and closure (interventional, laparoscopic clipping) if an increase in the size of the aneurysm is observed during monitoring.