1. Access route complications
- Incidence: 9–16% of all patients
- Injury to access vessels with or without acute thrombosis; bleeding complications; later also pseudoaneurysms and arteriovenous fistulae
- In particular in narrow, delicate or highly tortuous, calcified vessels
- Dissection; access vesssel occlusion; vascular rupture → stent implantation
- Bleeding complication at puncture site (5-8%) → mostly nonsurgical; surgical hematoma evacuation and suturing of the vessel required in <3% of cases
Prevention:
- Careful patient selection and preoperative assessment
- Correct selection of introducer set
Outer diameter of introducer set | Minimum vessel diameter |
14–16F | 6 cm |
17–21F | 7 cm |
22–25F | 8 cm |
2. Endograft malposition
- Most often, incorrect placement of the proximal tip of the endograft in relative to the renal arteries
Placement too inferior:
- Inadequate proximal seal → Endoleak type I
- Proximal extension with additional stent graft or bare-metal stent
Prevention:
- Careful pre-operative assessment
- Becoming familiar with the different markings on the endograft
Placement too superior:
- Accidental renal artery occlusion → probing of renal artery with Simmons Sidewinder 1 catheter or alternatively transbrachial approach + stenting of renal artery
- If interventional management is no longer possible ( often) → convert to open surgery
Endograft torquing
- Results in consecutive kinking of the graft limb with stenosis or occlusion of the limb → remedy by implantation of a self-expanding stent
Prevention:
- If the delivery system must be rotated for some compelling reason before before deploying the graft → retract the delivery system into the iliac vessels and advance it again once the position has been corrected