1. Access Route Complications
- Incidence: 9–16% of all patients
- Injury to access vessels with or without acute thrombosis; bleeding complications; later also pseudoaneurysm formation and arteriovenous fistulae
- In particular in narrow, delicate or highly tortuous, calcified vessels
- Dissection; occlusion of the access vessel; vascular rupture → stent implantation
- Bleeding complication at the puncture site (5–8%) → mostly nonsurgical; surgical hematoma evacuation with suturing of the vessel required in <3% of cases
Prevention:
- Careful patient selection and preprocedural assessment
- Correct selection of the introducer set
| Outer diameter of introducer set | Minimum vessel diameter |
|---|---|
| 14–16F | 6 mm |
| 17–21F | 7 mm |
| 22–25F | 8 mm |
2. Malposition of the Endograft
- Most often, incorrect placement of the proximal end of the endograft in relation to the renal arteries
Placement too inferior:
- Inadequate proximal seal → type I endoleak
- Proximal extension with an additional stent graft or bare-metal stent
Prevention:
- Careful preprocedural assessment
- Becoming familiar with the various markings on the endograft
Placement too superior:
- Accidental coverage of the renal arteries → cannulation of the renal artery using a Simmons Sidewinder 1 catheter or, alternatively, transbrachial approach + stent implantation in the renal artery
- If interventional management is no longer possible (often) → conversion to open surgery
Torquing of the Endograft
- Results in consecutive kinking of the graft limb with limb stenosis or limb occlusion → remedied by implantation of a self-expanding stent
Prevention:
- If rotation of the delivery system is absolutely necessary before deployment of the endograft → retract the delivery system into the iliac vessels and advance it again once the position has been corrected