Authors
Abrosimov A.A.1, Yamenskov V.V.1, Batrashov V.A.2, Marynich A.A.3
1 National Medical Research Center of High Medical Technologies Central Military Clinical Hospital named after A.A.Vishnevsky, Moscow
2 Pirogov National Medical and Surgical Center, Moscow
3 Moscow Municipial Clinical Hospital named after A.K. Eramishantsev, Moscow
Abstract
The endovascular repair of the abdominal aortic aneurysm allows treating patients with severe comorbid pathology. The traditional open surgery is a difficult intervention for the patient, which retains its significance at the present time, since it is accompanied by better results in the long term. The defining moment when choosing the final treatment method is the patient’s life expectancy.
For successful of the endovascular repair an abdominal aortic aneurysm, a favorable anatomy of the aneurysm, the selection of a stent graft, the presence of extensive experience of the operating surgeon, as well as sufficient material equipment of the medical institution is necessary. In addition, regular monitoring of postoperative complications is a prerequisite for the endovascular repair of an abdominal aortic aneurysm.
The risk of complications increases significantly if the aneurysms are unfavorable or difficult. Endovascular correction is performed from 15 to 25% of patients within 5 years after the initial operation. Up to 5% of patients need open surgical conversion.
The pre-existing protocols of postoperative follow-up turned out to be unsafe for the patient due to the regularly received radiation load and the nephrotoxic effect of the contrast agent during computed tomography. Therefore, there was a need to create a more rational approach in the prevention, diagnosis and treatment of complications after EVAR.
The article presents the main causes, diagnostic methods and principles of treatment of specific complications arising after endovascular repair of an abdominal aortic aneurysm.
Keywords: abdominal aortic aneurysm, conversion, stent-graft, endolic, endovascular repair.
References
1. Pokrovsky AV. Clinical angiology: A guide / A.V. Pokrovsky, editor. In 2 v. Vol. 2. — M.: Medicine, 2004. 888 p.: ill. (In Russ.)
2. Batrashov VA, Kostina EV, Chernyago TYu. Contribution of N.I. Pirogov to vascular surgery. Bulletin of the National Medical and Surgical Center named after N.I. Pirogov. 2020; 15(3): 85-94. (In Russ.) doi: 10.25881/BPNMSC.2020.34.19.016.
3. Dubost C, Allary M, Oeconomos N. Aneurysm of the abdominal aorta treated by resection and graft. Arch Mal Coeur Vaiss. 1951; 44(9): 848-51.
4. De Bakey ME, Cooley DA. Surgical treatment of aneurysm of abdominal aorta by resection and restoration of continuity with homograft. Surg Gynecol Obstet. 1953; 97(3): 257-66.
5. Volodos NL, Shekhanin VE, Karpovich IP. Self-expanding synthetic prosthesis for vascular endoprosthetics. Bulletin of Surgery.1986; 7: 123-125. (In Russ.)
6. Parodi JC, et al. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms // Annals of Vascular Surgery. 1991; 5: 491-499.
7. May J, et al. Endoluminal grafting of abdominal aortic aneurysms: causes of failure and their prevention. J Endovasc Surg.1994; 1: 44-52.
8. White GH, et al. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management J Endovasc Surg. 1997; 4(2): 152-68. doi: 10.1177/152660289700400207.
9. Veretenin VA. Ways to improve the results of treatment of patients with abdominal aortic aneurysms. [dissertation] M., 2009. (In Russ.)
10. Elliot L. Chaikof, et al. Atlas of Vascular Surgery and Endovascular Therapy: Anatomy and Technique. Boston, Massachusetts, 2014. 795 p.
11. Pokrovsky AV. The state of vascular surgery in 2018. Angiology and vascular surgery. Application. 2019; 2: 1-40. (In Russ.)
12. Daye D, et al. Complications of endovascular aneurysm repair of the thoracic and abdominal aorta: evaluation and management. Cardiovascular Diagnosis and Therapy. 2018; 8: 138-156. doi: 10.21037/cdt.2017.09.17.
13. Qiu J, et al. Early intervention effects of open repair and endovascular aortic repair on patients suffering from 40-54 mm abdominal aortic aneurysms: single center experience. Minerva Chir. 2017; 72(5): 391-396. doi: 10.23736/S0026-4733.17.07290-X.
14. Yin K, et al. Trends of 30-day mortality and morbidities in endovascular repair of intact abdominal aortic aneurysm during the last decade. J. Vasc. Surg. 2019; 69(1): 64-73. doi: 10.1016/j.jvs.2018.04.032.
15. Popov VA. Errors, dangers and complications in surgery of abdominal aortic aneurysms. Ways of prevention and methods of treatment. [avtoreferat dissertation]. M. 2000. (In Russ.)
16. Spiridonov AA, Tutov EG, Arakelyan VS. Surgical treatment of abdominal aortic aneurysms. M. Publishing house of the National Academy of Sciences named after A.N. Bakulev RAMS. 2000. 205 p. (In Russ.)
17. Burakovsky VI, Bokeria LA. Cardiovascular surgery. A guide for doctors. M: Medicine. 1989. 750 p. (In Russ.)
18. Zatevakhin II, Zolkin VM, Matyushkin AV, Tolstov PA, Tishchenko IS. On the pathogenesis and risk of rupture of abdominal aortic aneurysms. Angiology and vascular surgery. 2006; 12(1): 17-24. (In Russ.)
19. Francesco Stilo et al. Biomarkers in EndoVascular Aneurysm Repair (EVAR) and Abdominal Aortic Aneurysm: Pathophysiology and Clinical Implications. Diagnostics (Basel). 2022; 12(1): 183. doi: 10.3390/diagnostics12010183.
20. Kazanchyan PO, Popov VA. Complications in abdominal aortic aneurysm surgery. M.: MEI Publishing House, 2002. 302 p. (In Russ.)
21. Daijiro H, et al. Effect of endoskeleton stent graft design on pulse wave velocity in patients undergoing endovascular repair of the aortic arch. Gen Thorac Cardiovasc Surg. 2017; 65(9): 506-511. doi: 10.1007/s11748-017-0787-8.
22. Christoph F, et al. US-guided peripheral vascular interventions, comments on the EFSUMB guidelines. Med Ultrason. 2016; 18(2): 231-9. doi: 10.11152/mu.2013.2066.182.umb.
23. Popova IV, Karpenko AA, Ignatenko PV, Starodubtsev VB. Endoprosthetics of the aorta with an aneurysm of the infrarenal department in combination with occlusion of one of the iliac arteries. Angiology and vascular surgery. 2018; 2: 178-183. (In Russ.)
24. Chupin AV, Deryabin SV, Chigasov VA. Embolization of the internal iliac artery during endoprosthetics of an abdominal aortic aneurysm. Angiology and vascular surgery. 2019; 25(4): 76-81. (In Russ.) doi: 10.33529/ANGIO2019417.
25. Imaev TE, Kuchin IV, Lepilin PM et al. The use of an iliac branched endoprosthesis in endovascular treatment of abdominal aortic aneurysm and both common iliac arteries. Angiology and vascular surgery. 2016; 22(4): 83-86. (In Russ.)
26. Uhlmann МЕ, et al. Successful percutaneous access for endovascular aneurysm repair is significantly cheaper than femoral cutdown in a prospective randomized trial. J Vasc Surg. 2018; 68(2): 384-391. doi: 10.1016/j. jvs.2017.12.052.
27. Carpenter JP, et al. One-year pivotal trial outcomes of the Nellix system for endovascular aneurysm sealing. J Vasc Surg. 2017; 65(2): 330-336.e4. doi:10.1016/j.jvs.2016.09.024.
28. Shanil M, et al. Late renal artery stent fracture with pseudoaneurysm after fenestrated endovascular abdominal aortic aneurysm repair. J Vasc Surg Cases Innov Tech. 2019; 5(2): 149-151. doi: 10.1016/j.jvscit.2018.09.007.
29. De Bruin JL, et al. The Endovascular Sealing Device in Combination with Parallel Grafts for Treatment of Juxta/Suprarenal Abdominal Aortic Aneurysms: Short-term Results of a Novel Alternative. Eur J Vasc Endovasc Surg. 2016; 52(4): 458-465. doi: 10.1016/j.ejvs.2016.05.013.
30. Danielle M. Pineda et al. The fate of endovascular aortic aneurysm repair after 5 years monitored with duplex ultrasound imaging. J Vasc Surg. 2017 Aug;66(2):392-395. doi: 10.1016/j.jvs.2016.11.055.
31. Feras Z, et al. A systematic review of surveillance after endovascular aortic repair. J Vasc Surg. 2018; 67(1): 320-331. doi: 10.1016/j.jvs.2017.04.058.
32. Hyoung OK, et al. Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Comprehensive Review Korean J Radiol. 2019; 20(8): 1247-1265. doi: 10.3348/kjr.2018.0927.
33. Patent RUS №2752029 C1. Hafizov TN, Nikolaeva IE, Imaev TE. et al. Method of endovascular prevention of type I endolics during aortic endoprosthetics. (In Russ.)
34. Chaudhuri A. Endostapling Can Constrain Hyperangulated Neck and Successfully Treat a Proximal Type I Endoleak After EVAR. Eur J Vasc Endovasc Surg. 2016; 51(5): 681. doi: 10.1016/j.ejvs.2016.02.001.
35. Thomas FX, O’Donnell, et al. Select early type IA endoleaks after endovascular aneurysm repair will resolve without secondary intervention.J Vasc Surg. 2018; 67(1): 119-125. doi: 10.1016/j.jvs.2017.05.096.
36. Konstantinos S, et al. Systematic review and meta-analysis of migration after endovascular abdominal aortic aneurysm repair. Vascular. 2016; 24(3): 323-36. doi: 10.1177/1708538115590065.
37. Shanil MY, et al. Late renal artery stent fracture with pseudoaneurysm after fenestrated endovascular abdominal aortic aneurysm repair. J Vasc Surg Cases Innov Tech. 2019; 5(2): 149-151. doi: 10.1016/j.jvscit.2018.09.007.
38. Ben Li, et al. Pre-operative Aneurysm Thrombus Volume, But Not Density, Predicts Type 2 Endoleak Rate Following Endovascular Aneurysm Repair. Ann Vasc Surg. 2019; 57: 98-108. doi: 10.1016/j.avsg.2018.09.012.
39. Ziad Al A, et al. Compression of endograft limb after translumbar embolization of a type II endoleak using n-butyl cyanoacrylate. J Vasc Surg Cases Innov Tech. 2018; 4(4): 327-330. doi: 10.1016/j.jvscit.2018.06.001.
40. Rami OT, et al. Outcomes of using endovascular aneurysm repair with active fixation in complex aneurysm morphology. J Vasc Surg. 2018; 68(3): 683-692. doi: 10.1016/j.jvs.2017.12.039.
41. Motte LL, et al. Is EVAR a durable solution? Indications for reinterventions. J. Cardiovasc. Surg. Torino. 2018; 59(2): 201-212. doi: 10.23736/ S0021-9509.18.10388-0.
42. Laohapensang K, et al. Management of the infected aortic endograft. Semin. J. Vasc. Surg. 2017; 30: 91-97. doi: 10.1053/j.semvascsurg. 2017.11.001.
43. Takuya M, et al. Efficacy of Preoperative Antibiotic Therapy for the Treatment of Vascular Graft Infection. Ann Vasc Dis. 2018; 11(2): 191-195. doi: 10.3400/avd.oa.17-00128.
44. Khurram R, et al. Aortic endograft explantation in the setting of prior heterotopic renal allograft. J Vasc Surg Cases Innov Tech. 2018; 4(4): 275-277. doi: 10.1016/j.jvscit.2018.08.009.
45. Mohapatra A, et al. Increasing use of open conversion for late complications after endovascular aortic aneurism repair. J. Vasc. Surg. 2019; 69: 6: 1766-1775. doi: 10.1016/j.jvs.2018.09.049.
46. Ignatiev IM, Volodyukhin MYu, Zanochkin AV, Gizatullina NF, Rafikov AYu. Endoprosthetics of abdominal aortic aneurysm complicated by ischemic necrosis of the sigmoid colon. Angiology and vascular surgery. 2016; 22(4): 159-162. (In Russ.)
47. Popova IV, Ignatenko PV, Rabcun AA et al. Outcomes of endoprosthetic repair of abdominal aortic aneurism. Angiology and vascular surgery. 2021; 27(4): 59-69. (In Russ). doi: 10.33529/ANGIO2021402.
48. Ziad AA, et al. Long-term decline in renal function is more significant after endovascular repair of infrarenal abdominal aortic aneurysms. Journal of Vascular Surgery. J Vasc Surg. 2018; 68(3): 739-748. doi: 10.1016/j. jvs.2017.12.051.
49. Dang T, et al. Predictors of acute kidney injury after infrarenal abdominal aortic aneurysm repair in octogenarians. J Vasc Surg. 2019; 69(3): 752-762.e1. doi: 10.1016/j.jvs.2018.05.227.
50. Khabazov RI, Chupin AV, Kolosov RV, Deryabin SV. Endoprosthetics of an abdominal aortic aneurysm in a patient with a transplanted kidney. Angiology and vascular surgery. 2016; 22(3): 152-155. (In Russ.)
