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Surgery Today

Published in:

01-10-2014 | Original Article

Embolic complications after endovascular repair of abdominal aortic aneurysms

Authors: Naoki Toya, Takeshi Baba, Yuji Kanaoka, Takao Ohki

Published in: Surgery Today | Issue 10/2014

Abstract

Purpose

This retrospective study aimed to review our experiences with endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs), along with the incidence, risk factors and prognoses of associated embolic events. Our goal was to present the EVAR results and related risk factors from a single center, with a focus on embolic complications.

Methods

We retrospectively reviewed the data of 539 patients with AAAs who underwent elective EVAR at Jikei University from July 2006 to April 2009. Of these, 438 patients were selected after excluding those requiring fenestrated and branched EVAR.

Results

The technical success rate was 91.1 % (399/438) with no surgical mortality. Embolic complications occurred in nine patients (2 %), four of whom developed ischemic colitis and were successfully treated with bowel rest and hydration. Lower extremity atheroembolization and stroke occurred in three and one patients, respectively. Two patients died of cholesterol crystal embolization. Seven of the nine embolic complications (77.8 %) were associated with the use of Zenith stent-grafts. A Cox proportional-hazard regression analysis of the adjusted risk factors showed that smoking and severe arterial degeneration of the aorta, referred to as a shaggy aorta, to be independent predictors of embolic complications.

Conclusions

The presence of a shaggy aorta and a history of smoking are independent predictors of embolic complications associated with EVAR.

Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351:1607–18.PubMedCrossRef

Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364:843–8.PubMedCrossRef

Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005;365:2187–92.

Morimae H, Maekawa T, Tamai H, Takahashi N, Ihara T, Hori A, et al. Cost disparity between open repair and endovascular aneurysm repair for abdominal aortic aneurysm: a single-institute experience in Japan. Surg Today. 2012;42:121–6.PubMedCrossRef

Dadian N, Ohki T, Veith FJ, Edelman M, Mehta M, Lipsitz EC, et al. Overt colon ischemia after endovascular aneurysm repair: the importance of microembolization as an etiology. J Vasc Surg. 2001;34:986–96.PubMedCrossRef

Maldonado TS, Rockman CB, Riles E, Douglas D, Adelman MA, Jacobowitz GR, et al. Ischemic complications after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2004;40:703–9 (discussion 9–10).PubMedCrossRef

Rockman CB, Riles TS, Landis R. Lower extremity paraparesis or paraplegia subsequent to endovascular management of abdominal aortic aneurysms. J Vasc Surg. 2001;33:178–80.PubMedCrossRef

Hollier LH, Kazmier FJ, Ochsner J, Bowen JC, Procter CD. “Shaggy” aorta syndrome with atheromatous embolization to visceral vessels. Ann Vasc Surg. 1991;5:439–44.PubMedCrossRef

Amarenco P, Cohen A, Tzourio C, Bertrand B, Hommel M, Besson G, et al. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med. 1994;331:1474–9.PubMedCrossRef

10.

Fukuda I, Daitoku K, Minakawa M, Fukuda W. Shaggy and calcified aorta: surgical implications. Gen Thorac Cardiovasc Surg. 2013;61(6):301–13.PubMedCrossRef

11.

Sandison AJ, Edmondson RA, Panayiotopoulos YP, Reidy JF, Adam A, Taylor PR. Fatal colonic ischaemia after stent graft for aortic aneurysm. Eur J Vasc Endovasc Surg. 1997;13:219–20.PubMedCrossRef

12.

Thompson MM, Smith J, Naylor AR, Nasim A, Sayers RD, Boyle JR, et al. Microembolization during endovascular and conventional aneurysm repair. J Vasc Surg. 1997;25:179–86.PubMedCrossRef

13.

Lindholt JS, Sandermann J, Bruun-Petersen J, Nielsen JO, Fasting H. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report. Int Angiol. 1998;17:241–3.PubMed

14.

Jaeger HJ, Mathias KD, Gissler HM, Neumann G, Walther LD. Rectum and sigmoid colon necrosis due to cholesterol embolization after implantation of an aortic stent-graft. J Vasc Interv Radiol. 1999;10:751–5.PubMedCrossRef

15.

Thompson MM, Smith JL, Bell PR. Thromboembolic complications during endovascular aneurysm repair. Semin Vasc Surg. 1999;12:215–9.PubMed

16.

Zempo N, Sakano H, Ikenaga S, Harada M, Yamashita A, Morikage N, et al. Fatal diffuse atheromatous embolization following endovascular grafting for an abdominal aortic aneurysm: report of a case. Surg Today. 2001;31:269–73.PubMedCrossRef

17.

Liew YP, Bartholomew JR. Atheromatous embolization. Vasc Med. 2005;10:309–26.PubMedCrossRef

18.

Fine MJ, Kapoor W, Falanga V. Cholesterol crystal embolization: a review of 221 cases in the English literature. Angiology. 1987;38:769–84.PubMedCrossRef

19.

Beal MF, Williams RS, Richardson EP Jr, Fisher CM. Cholesterol embolism as a cause of transient ischemic attacks and cerebral infarction. Neurology. 1981;31:860–5.PubMedCrossRef

20.

Ezzeddine MA, Primavera JM, Rosand J, Hedley-Whyte ET, Rordorf G. Clinical characteristics of pathologically proved cholesterol emboli to the brain. Neurology. 2000;54:1681–3.PubMedCrossRef

21.

Zanen AL, Rietveld AP, Tjen HS. Cholesterol-embolism: diagnosis by endoscopy. Endoscopy. 1994;26:257–9.PubMedCrossRef

22.

Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A. The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am Coll Cardiol. 2003;42:211–6.PubMedCrossRef

23.

Kazmier FJ, Hollier LH. The “Shaggy” aorta. Heart Dis Stroke. 1993;2:131–5.PubMed

24.

Hayashida N, Murayama H, Pearce Y, Asano S, Ohashi Y, Kohno H, et al. Shaggy aorta syndrome after acute arterial macroembolism: report of a case. Surg Today. 2004;34:354–6.PubMedCrossRef

25.

Lyden SP, Sternbach Y, Waldman DL, Green RM. Clinical implications of internal iliac artery embolization in endovascular repair of aortoiliac aneurysms. Ann Vasc Surg. 2001;15:539–43.PubMedCrossRef

26.

Karch LA, Hodgson KJ, Mattos MA, Bohannon WT, Ramsey DE, McLafferty RB. Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2000;32:676–83.PubMedCrossRef

27.

Azizzadeh A, Sanchez LA, Miller CC 3rd, Marine L, Rubin BG, Safi HJ, et al. Glomerular filtration rate is a predictor of mortality after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2006;43:14–8.PubMedCrossRef

28.

Taylor PR, Reidy J, Scoble JE. Endovascular abdominal aortic aneurysm repair and renal function. Nephrol Dial Transplant. 2006;21:2362–5.PubMedCrossRef

29.

Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.PubMedCrossRef

30.

Amarenco P, Bogousslavsky J, Callahan A 3rd, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549–59.PubMedCrossRef

31.

Illuminati G, Bresadola L, D’Urso A, Ceccanei G, Vietri F. Simultaneous stent grafting of the descending thoracic aorta and aortofemoral bypass for “shaggy aorta” syndrome. Can J Surg. 2007;50:E1–2.PubMedPubMedCentral

Title: Embolic complications after endovascular repair of abdominal aortic aneurysms
Authors: Naoki Toya
Takeshi Baba
Yuji Kanaoka
Takao Ohki
Publication date: 01-10-2014
Publisher: Springer Japan
Published in: Surgery Today / Issue 10/2014
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-013-0795-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Embolic complications after endovascular repair of abdominal aortic aneurysms

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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