Background: Patients with abdominal or thoracic aortic aneurysms which have the concomitant arterial diseases that may complicate or even exclude them from necessary endovascular stent graft repair (EVAR). In the current study, we aimed to describe arterial injuries encountered during EVAR and supplementary vascular surgical procedures to enable EVAR.

Methods: Between 2002 - 2003, 13 selected high-risk patients treated for thoracic aortic aneurysm (TAA) and/or abdominal aortic aneurysm (AAA) with endovascular devices were reviewed. Seven patients were treated for TAA, four patients for AAA, and two patients for both AAA and TAA. Femoral artery was the access site for 12 patients and common iliac artery for one patient. Aortoiliac stent graft was used in four patients treated due to AAA and aorto-biiliac stent graft in two patients.

Results: In four cases, femoral artery injury was encountered during EVAR. In two cases saphenous vein graft interposition and patch plasty was performed for revascularization. Femoro-femoral bypass was performed in four patients who were treated with aorto-iliac stent grafts, after EVAR. The right subclavian to left carotico-subclavian bypass was performed in one patient with TAA, in order to enable endovascular stent deployment.

Conclusions: Endovascular stent graft treatment is widely used for the treatment of aortic aneurysms in selected and high-risk patients. However, vascular surgical interventions are always the part of the treatment, used either to repair access site injury or as supplementary to enable stent graft deployment.

Keywords : Abdominal aortic aneurysm, thoracic aortic aneurysm, interventional radiography, vascular surgery, endovasculer stent