From the Guidelines
Complications of abdominal aortic aneurysm (AAA) repair include both immediate surgical risks and long-term issues, with a mortality rate for elective AAA repair of approximately 2-5%, but rising significantly to 30-50% for emergency repair of ruptured aneurysms 1.
Immediate Complications
Common immediate complications include:
- Bleeding
- Infection
- Myocardial infarction
- Stroke
- Renal failure
- Respiratory problems Specifically, patients may experience graft infection (occurring in 1-3% of cases), which often requires graft removal and extra-anatomic bypass, as well as ischemic colitis affecting 1-3% of patients due to interruption of blood flow to the colon during surgery 1.
Long-term Complications
Long-term complications include:
- Anastomotic pseudoaneurysms
- Graft thrombosis
- Aortoenteric fistulas, which present as gastrointestinal bleeding Endovascular repair specifically carries risks of:
- Endoleaks (continued blood flow into the aneurysm sac)
- Device migration
- The need for reintervention Patients with pre-existing cardiac, pulmonary, or renal disease face higher complication rates, with coronary artery disease being the leading cause of early mortality after AAA repair, associated with a 5%–10% rate of peri-operative CV complications such as death, MI, or stroke 1.
Surveillance and Management
Post-operative surveillance is essential to detect complications early, typically involving regular imaging studies, and endovascular repair is associated with lower mortality (<1%) and CV complications, making the need for pre-operative cardiac evaluation critical 1.
From the Research
Complications of AAA Repair
The complications of Abdominal Aortic Aneurysm (AAA) repair can be categorized into several types, including:
- Graft-related complications
- Ischemic complications
- Gastrointestinal complications
Graft-Related Complications
Graft-related complications after AAA repair include:
- Anastomotic pseudoaneurysm (3.0%) 2
- Graft thrombosis (2.0%) 2
- Graft-enteric erosion/fistula (1.6%) 2
- Graft infection (1.3%) 2
- Anastomotic hemorrhage (1.3%) 2
- Colon ischemia (0.7%) 2
- Atheroembolism (0.3%) 2
Ischemic Complications
Ischemic complications after endovascular AAA repair include:
- Limb and pelvic ischemia 3
- Lower extremity ischemia (9.0%) 3
- Pelvic ischemia, including colon, buttock, and spinal cord ischemia 3
Gastrointestinal Complications
Gastrointestinal complications after ruptured AAA repair include:
- Prolonged adynamic ileus 4
- Acute pancreatitis 4
- Cholecystitis 4
- Perforated duodenal ulcer 4
- Bowel obstruction 4
- Antibiotic-associated colitis 4
- Ischemic colitis 4
- Bowel infarction 4
- Liver failure 4
Endovascular Repair Complications
Endovascular repair of AAA can also result in complications such as: