1. Complications of the Access Routes
- Frequency: 9-16 % of all patients
- Injuries to the access vessels with or without acute thrombosis, bleeding complications; later also pseudoaneurysm formation and arteriovenous fistulas
- especially in narrow, delicate or highly tortuous, calcified vessels
- Dissection, occlusion of the access vessel, vessel rupture → stent implantation
- Bleeding complication at the puncture site (5-8 %) → predominantly conservative; surgical haematoma evacuation with oversewing of the vessel required in < 3 % of cases
Prophylaxis:
- careful patient selection and preprocedural evaluation
- correct selection of the introducer set
Outer diameter of introducer set | Minimum vessel diameter |
|---|---|
14 – 16 F | 6 mm |
17 – 21 F | 7 mm |
22 - 25 F | 8 mm |
2. Malpositioning of the endoprosthesis
- usually incorrect placement of the proximal endograft end in relation to the renal arteries
placement too low:
- insufficient proximal sealing → type I endoleak
- proximal extension with a further stent graft or bare-metal stent
Prophylaxis:
- careful preprocedural evaluation
- familiarise oneself with the various markings on the endograft
placement too high:
- accidental coverage of the renal arteries → cannulation of the renal artery using a Simmons-Sidewinder-1 catheter or alternatively transbrachial access + stent implantation in the renal artery
- if interventional therapy is no longer possible (frequent) → conversion to open surgery
Torsion of the endoprosthesis
- leads to consecutive kinking in the prosthesis limb with limb stenosis or limb occlusion → correction with the implantation of a self-expanding stent
Prophylaxis:
- if rotation of the delivery system is absolutely necessary before deployment of the endoprosthesis → withdraw the delivery system into the iliac vasculature and re-advance after correcting the position