title: Incidence and treatment of intraoperative technical problems during endovascular repair of complex abdominal aortic aneurysms.
abstract: OBJECTIVE
  The purpose of this study was to assess the incidence and management of intraoperative technical problems during endovascular repair (EVR) of complex abdominal aortic aneurysms (AAA).
  
  
  METHODS
  From February 1995 to March 1999, 204 EVRs of nonruptured AAA were performed at our institution. One hundred seventy-six patients had an in-house custom-made graft; 172 were aorto-uni-iliac grafts, and four were aortoaortic grafts. Twenty- eight patients had a bifurcated graft. One hundred fourteen patients (56%) were high risk for conventional open repair. One hundred nine patients (53%) were not suitable for most commercially available devices.
  
  
  RESULTS
  Intraoperative technical problems occurred in 81 patients (40%). There were 37 endoleaks (27 proximal, 10 distal), 15 graft stenoses, one failure of graft deployment, two graft thromboses, three aortoiliac ruptures, five renal artery occlusions (one bilateral, four unilateral), and 18 internal iliac occlusions (five bilateral, 13 unilateral). Endovascular management of these problems was successful in 37 of the 81 patients (46%) and included 15 balloon dilatations, 21 additional stent placements, and one graft thrombectomy. Fifteen of the 81 patients (19%) had open procedures (four periaortic ligature placements, six open aneurysm repairs, three common iliac ligations, and two extra-anatomic bypass grafts). In the remaining 29 patients, the on-table problem was managed expectantly. During follow-up, two of 37 patients (5%) who were treated successfully with endovascular procedures experienced recurrence. There were five deaths (33%) among the 15 patients who underwent open procedures.
  
  
  CONCLUSIONS
  Intraoperative problems occur frequently during the endovascular management of complex aneurysms. Many of these problems can be managed with additional endovascular techniques without an increased risk of recurrence or procedure-related complications. Open procedures in high-risk patients carry a high mortality rate. The team performing EVR of AAA should be skillful in advanced endovascular and open surgical procedures.
authors.affiliation: Division of Vascular Surgery, Nottingham University Hospital, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Kalliafas
authors.forename: J N
authors.initials: JN
authors.lastname: Albertini
authors.forename: J
authors.initials: J
authors.lastname: Macierewicz
authors.forename: S W
authors.initials: SW
authors.lastname: Yusuf
authors.forename: S C
authors.initials: SC
authors.lastname: Whitaker
authors.forename: S T
authors.initials: ST
authors.lastname: Macsweeney
authors.forename: P W
authors.initials: PW
authors.lastname: Wenham
authors.forename: B R
authors.initials: BR
authors.lastname: Hopkinson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology; D001157:Arterial Occlusive Diseases / Q000209:etiology; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002404:Catheterization; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007083:Iliac Artery / Q000473:pathology / Q000601:surgery; D015994:Incidence; D007431:Intraoperative Complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000209:etiology; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome