Treatment of leaks after endovascular repair of aortic aneurysms

Radiology. 2000 May;215(2):414-20. doi: 10.1148/radiology.215.2.r00ma22414.

Abstract

Purpose: To evaluate leaks after the endovascular repair of aortic aneurysms and treat them with occlusive therapy.

Materials and methods: Seventy patients (11 women, 59 men), aged 26-82 years (mean, 69.2 years), underwent transfemoral insertion of endoluminal stent-grafts for treatment of aortic aneurysms. Indications were traumatic pseudoaneurysms (n = 5) or arteriosclerotic aneurysms (n = 65). Aneurysms were thoracic (n = 5) or infrarenal (n = 65). To exclude the possibility of leaks, spiral computed tomography (CT) was performed at 3-month intervals. Patients with leaks that persisted unchanged longer than 3 months were referred for angiography and occlusive therapy.

Results: At CT, 21 leaks were identified in 17 of 70 patients (24%). Only 11 of those 17 patients (65%) had leaks identified with conventional aortography. Selective angiography, however, depicted all of these. Eighteen of 21 leaks proved amenable to occlusive treatment: surgery (n = 1), further stent implantation (n = 4), or embolization (n = 13). In one leak, spontaneous occlusion occurred after 3 months. Two leaks in either the iliolumbar or the median sacral artery were inaccessible; one remained untreated, and the other was unsuccessfully treated. Mean follow-up of occlusive therapy was 6.8 months (range, 2-14 months).

Conclusion: Successful occlusion of perigraft leaks is feasible in most cases and can be performed without major complications.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Surgical / adverse effects*
  • Aneurysm, False / surgery
  • Angiography, Digital Subtraction
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Diseases / surgery
  • Aortography
  • Arteries / pathology
  • Arteriosclerosis / surgery
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Catheterization, Peripheral
  • Embolization, Therapeutic
  • Female
  • Follow-Up Studies
  • Humans
  • Ilium / blood supply
  • Lumbar Vertebrae / blood supply
  • Male
  • Middle Aged
  • Postoperative Complications / therapy*
  • Reoperation
  • Sacrum / blood supply
  • Stents / adverse effects*
  • Tomography, X-Ray Computed
  • Treatment Outcome