Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: an underdiagnosed entity.
OBJECTIVE
Early limb occlusions following endovascular treatment of aorto-iliac aneurysmal disease is not uncommon (4%-13%). To assess whether the femoral artery entry site could potentially cause this complication, we prospectively evaluated the ipsilateral common femoral artery (CFA) and distal external iliac artery (EIA) with intraoperative duplex scans (IDS).


METHODS
There were 134 patients with infrarenal nonruptured abdominal aorto-iliac aneurysms treated with endografts since 2002 at our institution. Age ranged from 65 to 89 years (mean: 77 +/- 7 years). Aneuryx (n = 41), Zenith (n = 50), and Excluder (n = 43) endografts were used for repair. All procedures were performed via open exposure of the CFA. Introducer diameter varied from 12 mm to 22 mm. All patients underwent IDS of the CFA and distal EIA after repair of the arteriotomies.


RESULTS
In 34 patients (25%), we documented intimal dissections causing severe (>70%) stenoses. Of the 271 arteries that were examined, 38 (14%) had abnormal findings that demanded intervention. These were repaired with flap excision, tacking sutures revision, or patch angioplasty (n = 36). Repeat IDS confirmed the adequacy of the repair. No statistical difference was noted if the site of larger introducer sheath and the incidence of flap formation. In addition, 10 small flaps or plaques were visualized but did not create significant stenosis. No differences were noted in the incidence of positive duplex exams between each type graft (P = .4). No early or late iliac limb occlusions were noted. Follow-up of 94% was obtained.


CONCLUSIONS
Completion arterial duplex scans are helpful in detecting a substantial number of clinically unsuspected technical defects caused by introducer sheaths. Timely diagnosis and repair of these defects may decrease the incidence of early limb occlusion following endograft placement.
Hingorani
Anil P
AP
Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA. ahingorani@maimonidesmed.org
Ascher
Enrico
E
Marks
Natalie
N
Shiferson
Alexander
A
Patel
Nirav
N
Gopal
Kapil
K
Jacob
Theresa
T
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D003251:Constriction, Pathologic; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D017543:Iliac Aneurysm / Q000601:surgery; D007083:Iliac Artery / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D007430:Intraoperative Care; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D012086:Reoperation; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000209:etiology