Vaskulárna medicína 1/2015

Complications of endovascular treatment of abdominal aortic aneurysm

Aim of the study:Endovascular treatment of abdominal aneurysm is not only effective alternative to surgical therapy, but it becomes to be a dominant therapeutic modality. Approximately 70 % of patients with abdominal aneurysm worldwide are treated with endovascular method. The purpose of the study was to evaluate the incidence of complications (total mortality, contrast-induced nephropathy, endoleak, need of reintervention, intestinal ischemia) in the group of patients, who underwent endovascular treatment of abdominal aneurysms (EVAR). Results: Between 2010 and 2014, 90 elective patients underwent treatment with the Endurant II bifurcated endoprothesis performed in Department of Angiology Cardiology Clinic VÚSCH Kosice. The average length of follow-up was 26.6 months. During the first 30 days no death was recorded, one patient died during follow-up. Contrast nephropathy occurred in 16.7 % of patients (n = 15), one third of which were patients with type 2 diabetes mellitus (DM2). Endoleak was documented in 16.7 % of patients (n = 15). Early endoleak type I with the need of early reintervention occurred in 2 patients. Type II endoleak without need of intervention was documented in 12 patients and late type endoleak III occurred in 1 patient. Patients with endoleak didn´t have higher risk of endovascular interventions in the future (OR 2.71; 95 % CI 0.7 to 10.4). Endovascular reintervention was needed in 16.7 % of cases (n = 15), in 2 patients was needed surgical therapy (femorofemoral bypass). DM2 did not increase the risk of endoleak and/or reintervention (OR 1.02; 95 % CI 0.36 to 2.86). Severe intestinal ischemia did not occurred. Abdominal discomfort with subileus was present in 2 patients with DM2 with improvement after conservative treatment. Conclusion:EVAR safe method of treating AAA. The incidence of complications after EVAR in our group of patients is comparable with abdominal aneurysm treatment centres. With the development of new stentgrafts fewer complications and reinterventions after endovascular treatment of AAA are expected.

Keywords: abdominal aortic aneurysm, EVAR, complications, endoleak, ischaemia.