The technical success rate for abdominal aortic endografting is high, and the overall rate of severe perioperative complications is lower compared with open surgical repair; however, the endograft remains a dynamic entity and late complications are more likely. Complications associated with endovascular abdominal aortic repair are usually related to some technical aspect of endograft placement such as problems with vascular access, or due to the structural integrity and stability of the endograft such as endoleak, endograft migration, or endograft collapse.
Endograft complications rarely lead to a need to convert to open surgery at the time of placement, and when they occur late, can usually be managed using endovascular means . Device-related complications are the main reason for reintervention (including late conversion), which is required in up to 30 percent of patients. The overall incidence of conversion is about two percent . Ischemic complications are often related to embolism, but may also be due to positioning the endograft and can affect the extremities, intestine, pelvic organs, spinal cord, or kidneys. Renal insufficiency can also be caused by the administration of intravenous contrast (eg, allergic reaction, contrast-induced nephropathy). The risk of ischemic complications increases with more complex endovascular repairs.
The complications associated with abdominal aortic endografting will be reviewed here. The indications for abdominal aortic endografting and technical aspects of endograft placement are discussed elsewhere. (See "Endovascular repair of abdominal aortic aneurysm" and "Surgical and endovascular repair of ruptured abdominal aortic aneurysm" and "Management of asymptomatic abdominal aortic aneurysm", section on 'Introduction'.)
ANATOMY OF THE ABDOMINAL AORTA
The aorta is the major arterial conduit conveying blood from the heart to the systemic circulation. The abdominal aorta lies slightly left of the midline to accommodate the inferior vena cava which is in close apposition. The branches of the aorta (superior to inferior) include the left and right inferior phrenic arteries, left and right middle suprarenal arteries, the celiac axis, superior mesenteric artery, left and right renal arteries in addition to occasional accessory renal arteries, left and right gonadal arteries, inferior mesenteric artery, left and right common iliac artery, middle sacral artery and the paired lumbar arteries (L1-L4) (figure 1).
The common iliac arteries most often arise at the level of the 4th lumbar vertebra. The common iliac artery bifurcates into the external iliac and internal iliac arteries at the pelvic inlet (figure 2). The internal iliac artery gives off branches to the pelvic viscera and also supplies the musculature of the pelvis. The external iliac artery passes beneath the inguinal ligament to become the common femoral artery .