Complications in aortic endografting

This interactive session was chaired by Piergiorgio Cao and Vincenti Riambau. Carlos Aguirre presented the case of a 26-year old woman with late stent thrombosis after percutaneous treatment of aortic coarctation. This uncommon complication was successfully treated with recannulisation using a radiofrequency ablation catheter and re-stenting. Vinay Kumar discussed the case of a 76-year old woman who developed an abdominal aortic rupture during endovascular aneurysm repair (EVAR). Urgent repair was needed and so an AneuRx® aortic cuff was modified to allow supra-renal fixation. This occluded both renal arteries, but right function was restored after cannulation. Guidewire use may prevent this type of occlusion in future procedures. Jacob Zeiani presented the case of a 68-year old woman with bleeding due to an aortooesophageal fistula. Instead of conventional surgical treatment, surgical transposition of the epiaortic vessels and endoprosthesis placement was used and lifelong antibiotic therapy prescribed. Sunil Wani discussed aortic coarctation in an asymptomatic 32-year old man. Stent sizing, positioning and careful post-dilatation is crucial for success and rapid pacing can stabilise the balloon.

In conclusion, in cases of aortic coarctation if stent deployment is too low, migration can occur. Aortic mismatch may also be important and facilitate the migration, malfunction and artery occlusion. Overdilatation of the aorta also needs to be avoided. For aorto-oesophageal fistula, endografting with partial branching can be a safe option. As recurrent infection is common, this should be prevented with prophylactic antibiotics and tight followup. Open surgical procedures are available as a final option. Endografting in patients with angulated or dilated aortic necks can be problematic and ballooning with overdilatation should not be performed due to the risk of rupture. Supra-renal stenting is a viable alternative. Guidewires can also be used in very short necks to aid recovery.