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Endovaskuläre Aneurysmaversorgung (EVAR)

Komplikationsmanagement

Endovascular aneurysm repair (EVAR)

Complication management

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Zusammenfassung

Im Rahmen der endovaskulären Versorgung (EVAR) von Bauchaortenaneurysmen (BAA) kann eine Vielzahl von Komplikationen auftreten. Die prozeduralen Komplikationen sind Verletzungen der Zugangsgefäße, Fehlplatzierung der Endoprothese, ischämische bzw. systemische Komplikationen und das Post-Implantationssyndrom. Die Spätkomplikationen sind femorale Pseudoaneurysmen, Endograft-Migration, -Kinking oder -Okklusion, Endoleckagen und Endograft-Infektion. Durch Sorgfalt bei der Patientenselektion und ausreichende präprozedurale Patientenvorbereitung kann die Inzidenz der Komplikationen verringert werden. Die meisten Komplikationen können entweder im Rahmen des Eingriffs oder während der Nachbeobachtung endoluminal beherrscht werden. Hierbei kommt einer adäquaten Lagerhaltung von Kathetern, Führungsdrähten, Stents, Stentgrafts und Embolisationsmaterialien eine große Bedeutung zu. In wenigen Fällen benötigen Blutungskomplikationen bzw. Pseudoaneurysmen am Zugangsgefäß, Endograft-Okklusionen und die Endograft-Infektion eine offen-chirurgische Sanierung. Für optimale Ergebnisse ist eine gute interdisziplinäre Zusammenarbeit, insbesondere zwischen den Interventionalisten, den Gefäßchirurgen und den Anästhesisten, unabdingbar.

Abstract

A variety of complications may be experienced during or after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA). Acute procedure-related complications include injury to the access vessels, improper endograft placement, ischaemic and systemic complications as well as the postimplantation syndrome. Femoral pseudoaneurysms, endograft migration, kinking or occlusion, endoleaks and endograft infection are complications that have been observed at follow-up. Meticulous patient selection and preprocedural work-up can reduce the incidence of these complications. The majority of the complications, acute as well those at follow-up, can be dealt with endoluminally. It is of essence, however, that a wide variety of catheters, guidewires, stents, stent–grafts and embolics are readily available in the repertoire of the interventionalist. In a small number of patients with endograft occlusion or infection or with bleeding complications/pseudoaneurysms of the access vessels, open surgical intervention may become necessary. To obtain optimal results, close interdisciplinary co-operation, especially between the interventionist, the vascular surgeon and the anaesthetist is mandatory.

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Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland

    S. Amin, J. Schnabel, O. Eldergash &  A. Chavan MD

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  1. S. Amin
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  2. J. Schnabel
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  3. O. Eldergash
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  4. A. Chavan MD
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Correspondence to A. Chavan MD.

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Interessenkonflikt

S. Amin, J. Schnabel, O. Eldergash und A. Chavan geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Amin, S., Schnabel, J., Eldergash, O. et al. Endovaskuläre Aneurysmaversorgung (EVAR). Radiologe 58, 841–849 (2018). https://doi.org/10.1007/s00117-018-0437-x

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  • DOI: https://doi.org/10.1007/s00117-018-0437-x

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