What are the recognized perioperative surgical com-plications associated with endovascular repairs?

What are the recognized perioperative surgical com-plications associated with endovascular repairs?

Although endovascular aortic repair is less invasive than open repair, it is nonetheless associated with significant perioperative complications. Prior to insertion of the endovascular device, the operator may be unable to pass the sheath or delivery device through the arteries because of iliac or aortic anatomy and/or pathology. Alternatively, the possibility of iatrogenic arterial rupture always exists with intra-arterial manipulations, which may necessitate emergent resuscitation and immediate conversion to an open procedure, thus increasing the morbidity and mortality associated with the repair.

Injury to the aorta and end organs may occur with guidewire insertion and device manipulation via either embolization or obstruction. Distal embolization of aortic material to the bowel, lower extremities, or other organs is not uncommon. Although the endovascular device may obstruct hypogastric artery flow, complications have not been reported. It is possible that either retrograde thrombo-embolism as a result of graft manipulation, large volumes of contrast injection, vigorous flushing, or the passage of guidewires through a diseased aortic arch may result in cerebral injury. Furthermore, inadvertent guidewire place-ment into the heart has occurred with injury to the aortic valve or pericardial tamponade.

Renal injury, either segmental or total, may occur as a complication of endovascular aortic repair. Graft migra-tion, renal artery dissection, and improper placement of the proximal portion of the endovascular device can occlude the renal arteries. This may lead to renal insuffi-ciency and the possibility of further procedures to correct the problem. A significant amount of contrast is used during these procedures to define aortic anatomy, providing another possible mechanism for renal injury.