World J Vasc Surg | Volume 6, Issue 1 | Review Article | Open Access

Complications of Endovascular Aortoiliac Aneurysm Repair – Narrative Review

Ribeiro MS1* and Becari C2

1Department of Surgery and Anatomy, Ribeirão Preto Medical School, Universidade de São Paulo, Brazil 2Department of Biological Sciences, School of Dentistry of Bauru, University of São Paulo, Brazil

*Correspondance to: Mauricio Serra Ribeiro 

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Endovascular Abdominal Aortic Aneurysm Repair (EVAR) complications can be divided into early and late complications. Early complications can be systemic when there is dysfunction of one or more organs, device complications, vascular access, or a combination of these. The most common vascular access complications are surgical site infections, postoperative hematoma, femoral artery injury, pseudoaneurysm, and local lymphocele or seroma. The use of percutaneous arterial closure devices provides a feasible and less invasive option for EVAR, with satisfactory technical success rates. Moreover, local complications may occasionally cause or worsen systemic dysfunctions. The current early mortality rate from EVAR is 0.6% to 1.7%. In large registry studies, the major complications rate such as myocardial infarction, pneumonia, and acute renal injury can be as high as 7.0%, 9.3%, and 5.5%, respectively. Endoleaks are the most common complication during follow-up, reaching 30% in 5 years, although kinking and thrombosis of the iliac branches are also frequent. Undoubtedly, compared to open repair (OSR), the main disadvantage of the endovascular technique is the high rate of reinterventions that, in the majority, are done to treat endoleaks. Regarding late mortality, well-conducted randomized studies demonstrate an advantage of the endovascular technique in the first two years, mainly due to lower early mortality. However, there is a convergence in the survival curves after two years, and the initial advantage of the endovascular technique is lost in the very long term. Over time, there is a trend of more aneurysm-related deaths in patients undergoing the endovascular technique. This is one of the reasons that recently led some publications still to recommend OSR for those patients with good clinical conditions.


Endovascular aneurysm repair; Aneurysm-related mortality; Complications; Abdominal aortic aneurysm; Device-related complications


Ribeiro MS, Becari C. Complications of Endovascular Aortoiliac Aneurysm Repair – Narrative Review. World J Vasc Surg. 2023; 6(1):1035..

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