Complications Arising Following Endovascular Repair of Aorto-iliac Aneurysms that Require Open Management: Ten Years’ Experience at a Single Centre

Abstracts

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Results: 17 patients underwent open, and 28 endovascular surgery for TASC D iliac disease. There were no significant differences between the groups with regard to age, gender or risk factors. There were 2 cases of primary failure in the endovascular group, and 4 early failures (within 30 days). Overall reintervention rate in the endovascular group was 50% and most were endovascular. Conclusion: The management of TASC D aortoiliac disease is complex. Endovascular techniques may offer reduced morbidity, mortality and recovery times, at the expense of a higher failure rate. The Diamond Intermediate Anastomotic Technique for Improving Outcomes in Composite Sequential Bypass Grafting in Critical Limb Ischaemic A.C. Rogers, P.W. Reddy, K.S. Cross, M.P. McMonagle University Hospital Waterford, Dunmore Rd, Waterford, Ireland

Objective: To describe and pilot a modified composite sequential bypass graft technique using a synthetic-vein graft combination linked via a common intermediate anastomosis to native artery in a diamond configuration. Methods: The Diamond composite sequential bypass procedure was performed on 6 patients with critical limb ischemia. Proximal graft consisted of ePTFE which was then anastomosed to native reversed vein in combination with a native intermediate artery in a diamond configuration. This distal bypass vein component was then tunnelled distally to anastomose to the distal outflow vessel. Results: All patients underwent above knee PTFE femoropopliteal bypass with popliteal distal vein grafting. Two of the patients also underwent aorto-bifemoral bypass grafting anastomosing both aorto-femoral and femoro-popliteal synthetic grafts in the diamond configuration. Limb-salvage was achieved in all six patients. Rupture of the distal segment occurred in one patient who developed a postoperative wound infection and required anastomotic revision. Conclusion: This study describes our initial experience with the novel diamond anastomosis, a modified configuration of prosthetic-to-vein grafting in composite sequential bypass procedures. In the absence of sufficient autologous vein, composite sequential grafting with the diamond anastomosis is a useful technique for infra-crural bypass grafting, which may be associated with improved graft patency and limb salvage. Complications Arising Following Endovascular Repair of Aorto-iliac Aneurysms that Require Open Management: Ten Years’ Experience at a Single Centre M. Bourke 1, T. Fitzgerald 1, N. Donlon 1, S. Flynn 1, S. Creedon 1, P. Sparrow 2, A. Brady 2, P. McEneaney 2, G. O’Brien 1, G. McGreal 1 2

Department of Surgery, Mercy University Hospital, Cork, Ireland Department of Radiology, Mercy University Hospital, Cork, Ireland

1

The incidence of early and late open conversion following endovascular aneurysm repair (EVAR) are reported at between 0.8% to 5.9% and 0.4% to 22% respectively. We sought to ascertain our experience of open management of aorto-iliac aneurysms complications following initial endovascular repair. Radiology records, theatre logbooks and HIPE data identified those patients that had EVARs performed, in addition to those who subsequently required open management of complications arising following, or at the time of, EVAR, between July 1st 2006 and December 31st 2015. Imaging, prior to and following EVAR, and procedure notes were studied for each patient. In the ten-year period, 153 patients underwent EVAR for aorto-iliac disease at our institution. All EVARs were performed electively. 12 patients (7.8%) subsequently required open repair following EVAR. In one instance, on-table conversion was performed due to occlusion of a renal artery. Technical complications with stent delivery, that is, failure to deploy and migration on deployment, necessitated conversion for two patients. In the other nine patients, open repair was necessary in order to manage limb occlusion (4), a type two endoleak (2), and one instance each of a type four endoleak, a type three endoleak and distal graft migration causing aneurysm rupture. Our data demonstrates that open re-intervention following EVAR is not uncommon. Lifelong surveillance of EVARs is essential, in addition to a focus, particularly among vascular trainees, on developing those skills necessary to perform what are frequently complex, open conversions. One Hundred Consecutive Ruptured Abdominal Aortic Aneurysms in an “Open Surgery for Ruptures” Centre in the “EVAR for Ruptures Era” e Lessons Learned N. Donlon, M. Bourke, S. Creedon, S. Flynn, T. Fitzgerald, G. O’Brien, G. McGreal Department of Surgery, Mercy University Hospital, Cork, Ireland

Efforts to reduce the morbidity and mortality associated with open repair for ruptured abdominal aortic aneurysms (AAA), in addition to advances in endovascular technology and expertise, has led some authors to advocate endovascular repair (EVAR) as the treatment of choice for ruptured AAA (rAAA). Reported outcomes, albeit hampered by inclusion biases, have shown reductions in perioperative mortality. In the absence of timely access to endovascular treatment options however, many centres, including our own, continue to manage rAAAs with standard open surgery. The aims of this study were to audit our outcomes managing ruptured AAAs in the open manner. In order that we might compare our results with published data from centres managing ruptures endovascularly, we looked at our early (30-day) outcomes from 100 consecutive ruptured AAAs that were operated on prior to July 1st 2015, and long term data on those for whom we had at