Leonardo Reis de Souza

Thromboembolic Complications During Endovascular Repair of Complex Aortic Aneurysms

Embolization of atheromatous debris is a known cause of major morbidity and mortality during complex endovascular repair. Potential complications include solid organ infarction, loss of renal function, bowel ischemia, and multisystem organ failure. Few studies have analyzed predictive factors of risk of atheroembolization during complex endovascular repair. We have recently analyzed atherosclerotic aortic wall thrombus (AWT) and clinical outcomes in 212 patients treated by fenestrated-branched endovascular aortic repair (F-BEVAR). Computed tomography angiography (CTA) was reviewed in all patients to determine the location, extent, and severity of atherosclerotic AWT. The aorta was divided into three segments and volumetric measurements of AWT were performed using Terarecon software. A classification system is proposed using objective assessment of number of affected segments, thrombus type, thickness, area, and circumference. AWT was classified as mild in 98 patients (46 %) and was considered moderate or severe in 114 (54 %). Solid organ infarction was present in 50 patients (24 %), acute renal injury occurred in 45 patients (21 %) by RIFLE criteria or 48 patients (23 %) by AKIN criteria. Patients with these complications had significantly higher (P < 0.05) AWT index scores. This chapter describes volumetric AWT assessment by image software and presents a novel score-based classification.

Renal Function Deterioration in Complex Aortic Repair

Deterioration of renal function is one of the most important determinants of early and late mortality after complex endovascular aortic repair. Renal function deteriorates in these patients because of multiple factors, including ischemia, catheter manipulation, embolization, contrast nephropathy, and occlusion of the renal arteries from intra-procedural complications or stent thrombosis. Approximately one third of the patients experience some loss of renal function and most recover to baseline values within three to six months. This chapter summarizes results of endovascular repair using fenestrated and branched endografts with respect to renal function outcomes.