Role of Intraoperative Completion Duplex Scan for Diagnosis of Iatrogenic Injuries of the Common Femoral Artery (CFA) and External Iliac Artery (EIA) during Endograft Placement

Abstract

Objective To assess whether the femoral artery entry site could cause early endograft limb occlusion complication, we prospectively evaluated the ipsilateral common femoral artery (CFA) with intraoperative duplex scans (IDS). Methods Forty-seven patients underwent 41 abdominal aortic and 8 common iliac artery (CIA) aneurysms repair with endografts. All procedures were performed via open exposure of the CFA. All patients underwent IDS of the CFA and distal external iliac artery after repair of the arteriotomies. Results Overall, there were 91 arteries assessed with IDS. Overall incidence of significant lesions requiring repair was 11 of 91 (12%). In 10 arteries (11%) we documented intimal flaps causing severe (>80%) stenoses that required repair. One more patient (1%) had no defects at the repair site, but low CFA peak systolic velocity with ratio 2:1 as compared with the contralateral CFA. Intraoperative abdominal duplex scan revealed a severe stenosis in the ipsilateral CIA that was not observed on the completion arteriogram. In addition, 13 (14%) nonsignificant flaps were visualized. No limb thromboses were noted in this group of patients on follow-up examinations. Conclusions IDS is helpful in detecting clinically unsuspected technical defects of the CFA. Timely diagnosis and repair of these defects may improve early patency of endograft limbs.