Assessment of EVAR Complications using CIRSE Complication Classification System in the UK Tertiary Referral Centre: A ∼6-Year Retrospective Analysis (2014–2019)

Purpose: To retrospectively analyse complications in endovascular aortic repair (EVAR) interventions and evaluate if the CIRSE (Cardiovascular and Interventional Radiological Society of Europe) complication classification system is appropriate as a standardized classification tool for EVAR patients. Materials and Methods: Demographic, procedural and complication data in 719 consecutive patients undergoing EVAR at one institution from January 2014 to October 2019 were retrospectively reviewed. Data (imaging reports, procedural reports, nurse notes, discharge summary reports) were collected consulting the electronic patient record system (EPR) of the hospital and cleaned and stored in a Microsoft Excel database. All the procedures were analysed in consensus by two interventional radiology consultants and a resident radiologist and if an intra- , peri- or post-procedural complication occurred, a grade (1–6) was assigned using the CIRSE grading complication classification system. Results: Twenty-five patients were excluded from the analysis because of invalid or incomplete data. The final population was made up of 694 patients (mean age 75,4 y.o., 616 male/78 female, min age 23 y.o., max age 97 y.o.). Complications emerged in 211 patients (30,4% of cases, 22 female/189 male). The number of patients with CIRSE grade I, II, III, IV, V and VI complications was 36 (17%), 17 (8%), 121 (57,3%), 15 (7,1%), 3 (1,4%), 19 (9%). Nineteen (2,6%) patients succumbed after EVAR. Thirty-four complications (16,1%) were related to vascular access. Conclusion: The CIRSE complication classification system represents a broadly applicable and feasible approach to evaluate the severity of complications in patients following EVAR. However, some deficit may be considered relevant and as starting standing-point for future improvements.