Complications Not Uncommon After Aortic Aneurysm Repair

Thromboembolic complications of endovascular aortic aneurysm repairs are not uncommon, usually asymptomatic and have the potential to be life threatening.

In certain isolated cases, perfusion abnormalities may respond to immediate lytic therapy with complete dissolution of the thrombus.

These are among findings of a study in Germany of the frequency and significance of these complications after endovascular treatment of aortic aneurysms.

Johannes Gorich and colleagues from the University of Ulm, Ulm, examined 174 patients (153 men and 24 women; mean age 71.4 years) before and after endovascular repair of aneurysms with a variety of endografts.

Thirty-eight of the patients had aneurysms of the thoracic and 136 of the abdominal aorta.

Pre-procedure, all patients were examined using three-phase helical computed tomography (CT) to determine appropriate endograft size. The first post-procedural CT scan was compared with preoperative findings to exclude occurrence of infarction in parenchymal organs.

Newly recognised perfusion deficits were considered evidence of infarction related to the procedure.

Overall, infarctions were detected in 16 (9.2 percent) patients: 13 in kidneys, two in the spleen, with one in the mesentery. Of all of these, only the mesenteric infarction was clinically symptomatic.

Both splenic infarctions were linked with deployment of stent-grafts in the thoracic aorta (5.3 percent of the 38 patients), while the mesenteric and 13 renal infarctions were seen in patients with infrarenal abdominal aortic aneurysms (0.7 percent and 9.6 percent, respectively, of 136 patients).

Complete thromboembolic occlusion of a renal artery experienced by one patient was partially recanalised with intraoperative lysis.