Endovascular complications

Georgiadis et al. Stroke 2002 33(6) 1584-1588 Nonblinded prospective hemicraniectomy for nondominant and cooling for dominant hemisphere 19 of 36 tx with hypothermia Hypothermia to 33°C with cooling blankets or endovascular technique on clinical course in pts with >2/3 MCA infarct 12% vs. 47% mortality for surgery vs. hypothermia. Hypothermia with increased complications of hypotension and electrolyte abnormalities. Both tx with longer ICU course... 

The endovascular procedure is most frequently used to treat infrarenal AAAs that are a leading cause of death in the older population, As our population ages, we will encounter AAAs more frequently than ever before. An aneurysm is defined by a size greater than 5 cm or 2.5 times the normal diameter of the native artery. Most aneurysms begin below the renal arteries and end close to the iliac bifurcation. More complicated AAAs exist involving the suprarenal aorta and visceral vessels and extending into the iliac arteries. The prevalence of AAAs is 3% to 10% for patients older than 50 years (I). They occur more frequently in men and reach a peak incidence close to the age of 80 years. AAA rupture is associated with an 80% to 90% mortality rate and therefore the focus of AAA treatment is on intervening before the aneurysm ruptures elective repair has mortality rate of less than 5%. 

Endovascular aneurysm repair (EVAR) of AAAs, results in a quick recovery, can be done under local anesthesia and has fewer systemic complications than open surgical repair. The goal of this chapter is to describe patient and aneurysm... 

Elkouri S, Gloviczki P McKusick MA, et al. Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms. J Vase Surg 2004 39(3)497-505. 

I Maldonado TS, Rockman CB, Riles E, et al. Ischemic complications after endovascular abdominal aortic aneurysm repair. J Vase Surg 2004 40(4) 703-709 discussion 9-10. 

For subarachnoid hemorrhage surgical clipping of the causative aneurysm or resection of the arteriovenous malformation is the mainstay of treatment. Endovascular coiling of the aneurysm can also be performed. Post-operative infection (either brain or respiratory) is an uncommon complication and not believed to be any more common than after other invasive surgical procedures. Hypervolemic-hemodilution and hypertensive (HHH) therapy is used to prevent spasm. There may be a role for anti-inflammatory measures for the prevention of vasospasm and delayed cerebral ischemia, as shown in a recent pilot study of patients treated with statins (Lynch et al., 2005). 

In patients with hemorrhagic stroke, an assessment of whether the patient is a candidate for surgical intervention via an endovascular or craniotomy approach should be made. Once the patient is out of the hyperacute phase, attention is placed on preventing worsening, minimizing complications, and instituting appropriate secondary prevention strategies. The acute phase of the stroke includes the first week after the event. ... 

Radioembolization is a newly developed technique which takes advantage of the synergy of endovascular embolization and of brachy therapy in the treatment of cancer. It offers new perspectives for achieving local control of tumor growth with a low rate of complications. 

Agarwal SK, Kamireddy S, Nemec J et al (2009) Predictors of complications of endovascular chronic lead extractions from pacemakers and defibrillators a single-operator experience. J Cardiovasc Electrophysiol 20(2) 171-175... 

The advance of endovascular therapy for aorto-iliac aneurysmal disease has also brought about yet another flourishing application of embolotherapy. Embolization of the internal iliac artery plays an important adjunct initial modality to allow endovascular treatment of aortic aneurysms with extension into the common iliac arteries [78-80], It also plays an crucial role in the secondary management of complications related to endoleaks [81-84],... 

Embolization therapy has become a major arm of modern interventional therapy. Its applications have become fundamental cores in the multimodality treatment paradigms in trauma, oncology, and endovascular therapy of vascular malformations and aneurysms. Knowledge of different techniques, materials and vascular anatomy and variants is essential to obtain good clinical outcome and minimize complications. 

Qureshi Al, Luft AR, Sharma M, Guterman LR, Hopkins LN (2000) Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures Part 1-Pathophysiological and pharmacological features. Neurosurgery 46 1344-1359... 

It is important to consider the risk of necrosis of neighb oring tissues and of the skin when using alco -hoi by a percutaneous or endovascular route. The risk of systemic toxicity increases in doses above 1 ml/kg or if a volume greater than 60 ml is used. Complications can be as high as 15% of patients treated with absolute alcohol (range 7.5%-23%) [105]. Severe complications such as cardiac arrest and pulmonary embolism have been reported [106,... 

Preventive measures such as surgical or endovascular revascularization of IIA may become necessary in patients who are at high risk of developing complications after IIA embolization (Table 15.2). Surgical bypass to IIA has been reported with good outcome in this setting [32]. Use of endografts with fenestrated iliac limbs is another alternative in such individuals. 

Endovascular prosfheses, assembled from tubular textile fabric and wire stent components, are deployed and expanded non-invasively from catheters for the rq>air of aneurysms in medium and large caliber arteries. Now that the implantation procedure is no longer experimental and these devices are becoming widely accepted and used for a growing cohort of patients, so the incidence of reported cases of late complications continues to grow. Observations from our own implant retrieval programme have led us to report that certain styles and models of endovascular prostheses are associated with particular failure mechanisms, such as endoleaks, migration, thrombosis, stent disruption, as well as fabric distortion and perforation. 

McDonnell, C. O. (2008). Percutaneous endovascular abdominal aortic aneurysm repair leads to a reduction in wound complications. Irish J Med Sei, 177(1), 49-51. 

Merland JJ, Rufenacht D, Laurent A et al. (1986) Endovascular treatment with isobutyl cyanoacrylate in patients with arteriovenous malformation of the brain indications, results and complications. Acta Radiol 369 621-622... 

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