Review article

https://doi.org/10.21860/medflum2024_316228

Surgical Management of Late Complications After Endovascular Treatment of Abdominal Aortic Aneurysm

Miljenko Kovačević ; Klinički bolnički centar Rijeka, Klinika za kirurgiju, Zavod za vaskularnu kirurgiju, Rijeka, Hrvatska
Lovro Kovač ; Klinički bolnički centar Rijeka, Klinika za kirurgiju, Zavod za traumatologiju, Rijeka, Hrvatska *
Lovro Tkalčić ; Sveučilište u Rijeci, Fakultet zdravstvenih studija, Katedra za radiološku tehnologiju, Rijeka, Hrvatska

* Corresponding author.

Abstract

Abdominal aortic aneurysm (AAA) is more common in the elderly population, and the risk of rupture correlates with the diameter of the aneurysm. Traditionally, patients with larger AAA were treated with open surgical techniques, but over the last 20 years, there has been an increase in the use of the endovascular aneurysm repair technique (EVAR), which involves placing a prosthetic impermeable graft within the lumen of the abdominal aorta to exclude the aneurysm from circulation and prevent rupture. The safety profile and long-term data of the EVAR method have resulted in a significant increase in the use of EVAR, despite studies that have not shown better survival or quality of life with long-term follow-up. Due to the increasing number of patients treated with EVAR, we expect an increase in the number of complications and the need for secondary interventions. The most common complications after EVAR include endoleak, stent graft migration, kinking of the prosthesis, thrombosis, and graft infection. Complications secondary to EVAR should primarily be managed endovascularly, but late complications requiring open surgery can be expected in up to 9% of patients who have undergone EVAR. Surgeries of the abdominal aorta secondary to failed EVAR are accompanied by a greater number of complications than the primary open procedures. Open surgery is almost always necessary for secondary rupture of AAA if endovascular options are not immediately available or technically feasible, as well as for graft infection, where complete extraction of the prosthetic material is desirable. The monitoring of patients after EVAR and the timely and elective management of complications are crucial.

Keywords

Aortic Aneurysm, Abdominal; Computed Tomography Angiography; Endoleak; Endovascular Aneurysm Repair; Stents

Hrčak ID:

316228

URI

https://hrcak.srce.hr/316228

Publication date:

1.6.2024.

Article data in other languages: croatian

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