1. Complications of Access Routes
- Frequency: 9-16 % of all patients
- Injuries to 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 puncture site (5-8 %) → mostly conservative; surgical hematoma evacuation with vessel suturing required in < 3 % of cases
Prophylaxis:
- careful patient selection and preprocedural evaluation
- correct selection of the introducer set
Outer diameter introducer set | Minimum vessel diameter |
|---|---|
14 – 16 F | 6 mm |
17 – 21 F | 7 mm |
22 - 25 F | 8 mm |
2. Misplacement of the Endoprosthesis
- mostly incorrect placement of the proximal endograft end in relation to the renal arteries
too low placement:
- insufficient proximal sealing → Endoleak Type I
- proximal extension with another stent graft or bare-metal stent
Prophylaxis:
- careful preprocedural evaluation
- familiarize oneself with the various markings on the endograft
too high placement:
- accidental coverage of the renal arteries → Probing of the renal artery using Simmons-Sidewinder-1 catheter or alternatively transbrachial access + stent implantation in 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 flow path and re-advance after correcting the position