Access-related complications in endovascular neurosurgery

The proliferation of endovascular surgery for neurosurgical indications has resulted in the need for sincere reappraisal of the pitfalls and complications inherent in these procedures. The first step towards treating a complication is awareness and recognition of the problem. Complications during endovascular procedures can range from those occurring at the site of access to anywhere along the vascular roadmap as a result of the intravascular access. Additionally, the menu of access sites is vast, with possible puncture sites being femoral, radial or directly trans-carotid or even transcranial. This chapter provides a comprehensive list of tips and tricks to recognize, diagnose, manage and most importantly prevent complications from vascular access. The chapter is designed for easy access to material since it heavily relies on tables and figures drawn from the authors’ personal cases. Issues such as groin hematoma, pseudo aneurysm, thromboembolism and nephrotoxicity among others are described in detail along with steps towards complication avoidance. Much of the complications described are common across the spectrum of angiographic procedures in general and the chapter can serve as a resource for interventional cardiologists, radiologists and vascular surgeons.