Postoperative endoleak after EVAR and effective endovascular reintervention. The case of the 64-year old male with abdominal aortic aneurysm with concomitant common iliac artery aneurysm.
, 2, 2, 3, 2, 2
Abstract
Endovascular aneurysm repair (EVAR) is a widely accepted alternative for open surgical repair (OSR) in the treatment of an abdominal aortic aneurysm (AAA). Metaanalyses of randomized controlled trials revealed significantly lower short-term mortality after EVAR procedure than OSR. From a technical point of view, proper sizing and selection of the stent-graft is very important. Most instructions for use (IFUs) of the current endografts recommend 10-20% oversizing concerning the preoperative aortic diameter. It can prevent endoleaks or subsequent complications such as displacement of the leg to the abdominal aneurysmal sac. In this paper, we present a case of a 64-year old male with a history of abdominal aortic aneurysm with concomitant common iliac artery (CIA) aneurysm. The patient underwent endovascular implantation of bifurcated stent-graft with extension to the right common iliac artery. He was admitted to the Department of Vascular Surgery due to increasing pain in the right-lower abdomen. The analysis of the imaging examination and the symptoms of an increasing lower limb ischaemia caused by deformation of the stent-graft allowed to decide for an endovascular intervention involving the implantation of the iliac side branch device (IBD). Postoperative angiography confirmed the correct location of the IBD with proper blood flow. After five days the patient was discharged home.
Keywords: (EVARiliac side branch deviceendoleakcommon iliac artery aneurysm).
References
- Crighton, E Public health screening program annual report: 1 April 2018 to 31 March 2019. (2020).
- Picel AC, Kansal N. Essentials of endovascular abdominal aortic aneurysm repair imaging: postprocedure surveillance and complications. AJR Am J Roentgenol. 2014; 203(4): W358–W372.
- Maleux G, Koolen M, Heye S. Complications after endovascular aneurysm repair. Semin Intervent Radiol. 2009; 26(1): 3–9.
- Al-Jubouri M, Comerota AJ, Thakur S, et al. Reintervention after EVAR and open surgical repair of AAA: a 15-year experience. Ann Surg. 2013; 258(4): 652–7; discussion 657.
- Paravastu SC, Jayarajasingam R, Cottam R, et al. Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev. 2014(1): CD004178.
- Becquemin JP, Pillet JC, Lescalie F, et al. ACE trialists. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients. J Vasc Surg. 2011; 53(5): 1167–1173.e1.
- Prinssen M, Verhoeven ELG, Buth J, et al. Dutch Randomized Endovascular Aneurysm Management (DREAM)Trial Group. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004; 351(16): 1607–1618.
- Patel R, Sweeting M, Powell J, et al. Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. The Lancet. 2016; 388(10058): 2366–2374.
- Lederle F, Freischlag J, Kyriakides T, et al. Long-Term Comparison of Endovascular and Open Repair of Abdominal Aortic Aneurysm. New England Journal of Medicine. 2012; 367(21): 1988–1997.
- d'Audiffret A, Desgranges P, Kobeiter DH, et al. Follow-up evaluation of endoluminally treated abdominal aortic aneurysms with duplex ultrasonography: validation with computed tomography. J Vasc Surg. 2001; 33(1): 42–50.
- Kranokpiraksa P, Kaufman JA. Follow-up of endovascular aneurysm repair: plain radiography, ultrasound, CT/CT angiography, MR imaging/MR angiography, or what? J Vasc Interv Radiol. 2008; 19(6 Suppl): S27–S36.
- Brown LC, Greenhalgh RM, Powell JT, et al. EVAR Trial Participants. Use of baseline factors to predict complications and reinterventions after endovascular repair of abdominal aortic aneurysm. Br J Surg. 2010; 97(8): 1207–1217.
- van Prehn J, Schlösser FJV, Muhs BE, et al. Oversizing of aortic stent grafts for abdominal aneurysm repair: a systematic review of the benefits and risks. Eur J Vasc Endovasc Surg. 2009; 38(1): 42–53.
- https://www.cookmedical.com/products/ndo_aaamain_webds/.
- Conrad MF, Adams AB, Guest JM, et al. Secondary intervention after endovascular abdominal aortic aneurysm repair. Ann Surg. 2009; 250(3): 383–389.
- Patel SR, Allen C, Grima MJ, et al. A Systematic Review of Predictors of Reintervention After EVAR: Guidance for Risk-Stratified Surveillance. Vasc Endovascular Surg. 2017; 51(6): 417–428.
- Bendermacher BLW, Stokmans R, Cuypers PhW, et al. EVAR reintervention management strategies in contemporary practice. J Cardiovasc Surg (Torino). 2012; 53(4): 411–418.
- Verzini F, Parlani G, Romano L, et al. Endovascular treatment of iliac aneurysm: Concurrent comparison of side branch endograft versus hypogastric exclusion. J Vasc Surg. 2009; 49(5): 1154–1161.
- Donas KP, Torsello G, Pitoulias GA, et al. Surgical versus endovascular repair by iliac branch device of aneurysms involving the iliac bifurcation. J Vasc Surg. 2011; 53(5): 1223–1229.