[Complications].

Abstract

Transluminal endovascular stent grafts placement has recently been introduced as a promising alternative to surgical treatment of aortic aneurysms, but complications can occur. Mortality, aneurysm rupture, massive microembolization, paraplegia, endoleaks, and graft migration are significant problems associated with endovascular aneurysm repair. An endoleak, defined as persistence of blood flow within the aneurysm sac outside the lumen of the stent graft, is among the most common complications and is a major problem because it may permit aneurysm expansion and rupture. Endoleaks are caused by inadequate hemostatic sealing at the proximal or distal attachment site or by retrograde sac perfusion through patent aortic branch vessels; the reported incidence varies from 10-40%. In the treatment of thoracic aortic aneurysms, the occurrence of paraplegia is considered to be the Achilles heel of this technique, because reconstruction of intercostal arteries is impossible. Coverage of the intercostal artery, which is thought to be important for distal spinal cord blood supply, with stent grafts should be avoided. Although we consider this exciting new technique holds great promise for aortic aneurysm repair, further advances in device technology are necessary to minimize the risk of complications with this procedure.