1. Complication of needle aquired vascular access-when to call a vascular surgeon K.GUIROV MMA- Sofia

2. Complications in EVAR – 3 categories 1. Access failure 2. Vessel compromise 3. Haemodynamic compromise -they result in conversion to open repair -Endoleak- The Achiles’ heel of EVAR 2 Bulgarian Endovascular Course 2011

3. Endoleak ~ 19%(C.Donayre et al – 2008) In 15% of them with persistent endoleak and continued aneurysm sac enlargement need a surgical conversion to prevent rupture. 3 Bulgarian Endovascular Course 2011

4. Vascular complications after coronary stent placement (101patients)-16% in general Femoral artery pseudoaneurysm-11% Haematoma, requiring surgery – 4% A-V fistula 1% Manual compression – 22,8% Pneumatic compression device- 2,4% (Sridhar Ketal-1996) 4 Bulgarian Endovascular Course 2011

5. Complications after iliac artery intervention (PTA with or without stenting) Review of literature – 7,9% to 23,7% complications 15% of the cases – no specific treatment was required 70% - endovascular approach 15% - surgery to treat the complications (H.Ahmed et al 2005) 5 Bulgarian Endovascular Course 2011

6. 1. Access site complications :  Groin haematoma  Retroperitoneal bleeding  Pseudoaneurysm  A-V fistula 2. Dissection – 7%- stent 3. Rupture – 0,8%  Balloon tamponade, covered stent or surgery 6 Bulgarian Endovascular Course 2011

7. 4. Distal embolization – 8,5%-24%  Acute limb ischemia -Thromboaspiration ? -Throbolysis ? -Surgical thrombectomy ? 5. Stent misadventure  Acute stent thrombosis  Balloon rupture with particle stent deployment  Stent crunch  Stent migration 7 Bulgarian Endovascular Course 2011

8. New generation stentgrafts  Low profile delivery systems  New percutaneous closure devices They make totally percutaneous approach possible and desirable and reduce the number of vascular complications 8 Bulgarian Endovascular Course 2011

9. Our experience (2005) -for 9 months 56 patients went through stenting procedure -3 (5,3%) stents occluded All of them went to conversion to open surgery: thrombectomy of the stent, followed by an arterial reconstructive surgery. 9 Bulgarian Endovascular Course 2011

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15. Conclusions: -the early, intraoperative thrombectomy is an appropriate choice, but rethrombosis is a must - relying on good late results is an illusion - arterial reconstructive surgery is an only option after the stent thrombosis 15 Bulgarian Endovascular Course 2011

16. Thanks for Your Attention! The vascular surgeon should watch the interventionalists back. 16 Bulgarian Endovascular Course 2011