Result and Risk Analysis of Iliofemoral Complications during TEVAR

Seimei Go, Keijiro Katayama, Shohei Morita, Tatsuya Kurosaki, Shinya Takahashi, Taijiro Sueda

Hirpshima University, Hiroshima, Japan

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – A

Abstract

Objective) 

The aim of this study was to evaluate outcomes of iliofemoral complications during thoracic endovascular aortic repair (TEVAR).

Methods)

 Between June 2011 and May 2017, 254 consecutive patients underwent TEVAR for thoracic aortic pathology. Access to the aorta was through the femoral artery in 196 cases, the iliac artery in 45 cases, and other pathways (including iliofemoral bypass, abdominal aorta and ascending aorta)in 13 cases.

Results)

There were 11 cases (4.3%) with iliofemoral complications during TEVAR that required repair at the injury site. In 5 cases, there was bifurcated graft replacement for abdominal aortic aneurysm (AAA). The iliac artery was injured in 7 cases, the femoral artery was injured in 2 cases, and the graft was injured in 2 cases. The secondary operations included iliofemoral bypass in 4 cases, interposition of the injury site in 2 cases, direct suturing in 2 cases, intimal repair in 2 cases, and endovascular repair in 2 cases. There was 1 death (9.0%) in the hospital due to pneumonitis. Multivariate analysis showed that thoracic atherosclerotic aneurysm (TAA) (P=0.03; OR, 9.80; 95% CI, 1.21-79.0) and

post-bifurcated graft replacement for AAA (P<0.01; OR, 6.03; 95% CI, 1.66-22.0) is a significant independent risk factor for iliofemoral complications.

Conclusion) 

Repair of AAA using a bifurcated graft can result in iliofemoral complications. Extreme care is needed to insert the stent graft. We expect the next generation of low-profile devices to reduce the risk of iliofemoral complications.