title: Endovascular repair of postoperative vascular graft related complications after aorto-iliac surgery.
abstract: OBJECTIVE
  Para-anastomotic aneurysms, leakage due to anastomotic failure, aorto- and arterioenteric fistulas are some of the serious complications after aorto-iliac surgical reconstructions. Treatment of these complications is challenging and is either done by open surgery or by endovascular therapy. The mortality and morbidity is higher compared to the initial treatment. We present twelve patients with these complications which were treated by an endovascular approach.
  
  
  METHODS
  From January 2008 through January 2013 our radiological records were searched for cases with post surgical vascular complications treated with endovascular intervention. These comprised of anastomotic pseudoaneurysm, suture leakage and arterial enteric fistulas. Patients with limb occlusions were not included in this study.
  
  
  RESULTS
  Twelve patients with graft related complications treated with endovascular intervention were recorded. There were four women and eight men with a mean age 75,3 years (range 48-80). At the time of diagnosis, 9 patients (75%) had symptoms and three (25%) was incidentally discovered. Six patients had leakage due to suture failure. All infective parameters were within normal limits. Four patients presented with anastomotic pseudoaneurysms without leak, of which three had proximal anastomotic pseudoaneurysms and one had distal iliac anastomotic pseudoaneurysm. Implanted stent graft were Endurant (Medtronic) bifurcated endoprostheses in three patients and Excluder (Gore) prosthesis in a two cases. Tubular Medtronic endoprosthesis was implanted in one case and in two cases aortic cuff was used. Fluency periphery stent grafts were used in four cases. There was a 100% technical success. Intervention related early mortality was 8%. One patient with pseudoaneurysm died 28 months after endovascular treatment because of cardiac infarct and one patient with previously infected arterio-enteric fistula and advanced malignancy died 7 months after second endovascular treatment. Overall the mortality was 25%. There was no procedure related morbidity or complications during hospitalization and follow-up of mean 12, 3 months (range 1-36 months) in the other 9 patients. There were no complications like endoleaks or limb occlusions.
  
  
  CONCLUSIONS
  Endovascular treatment of vascular graft related postsurgical complications is a valuable therapeutic option followed by lower mortality and morbidity rates compared with re-operation. Short and midterm follow-up is without severe complications and if it occurs most of them can be treated by endovascular means again.
authors: Department of Radiology, Odense University Hospital, Odense, Denmark - duvnjak.stevo@gmail.com.
authors: S
authors: S
authors: Duvnjak
authors: P E
authors: PE
authors: Andersen
authors: K E
authors: KE
authors: Larsen
authors: O
authors: O
authors: Roeder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013536:Suture Techniques / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*