Aortic endograft complications - Revision history

Danbot: Add verified PubMed references (PMIDs 35822261)

2026-03-22T10:57:06Z

Add verified PubMed references (PMIDs 35822261)

← Older revision		Revision as of 10:57, 22 March 2026
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	==Background==		==Background==
	[[File:Aneurysm endovascular.jpg\|thumb\|Endovascular aneurysm repair procedure]]		[[File:Aneurysm endovascular.jpg\|thumb\|Endovascular aneurysm repair procedure]]
	*Patients with Endovascular Aortic Repair (EVAR) can have unique complications that are not discussed in most emergency medicine literature.		*Patients with Endovascular Aortic Repair (EVAR) can have unique complications that are not discussed in most emergency medicine literature. <ref>Skrypnik D, et al. Late Endograft Migration After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-analysis. J Endovasc Ther. 2024 Feb;31(1):7-18. PMID 35822261</ref>
	*EVAR has largely replaced open aortic repair as the gold standard for the treatment of Abdominal Aortic Aneurysm (AAA).		*EVAR has largely replaced open aortic repair as the gold standard for the treatment of Abdominal Aortic Aneurysm (AAA).
	*Common complications including aortoenteric fistula, endoleaks, and graft thrombosis can present in a similar fashion to other common ED diagnoses.		*Common complications including aortoenteric fistula, endoleaks, and graft thrombosis can present in a similar fashion to other common ED diagnoses.

Rossdonaldson1: /* EVAR Complications */

2020-08-05T23:04:48Z

EVAR Complications

← Older revision		Revision as of 23:04, 5 August 2020
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	*Aortoenteric Fistula (most common)- expect symptoms of GI bleeding.		*Aortoenteric Fistula (most common)- expect symptoms of GI bleeding.
	*Endoleaks- Vascular flow outside of the graft that is still contained in the aortic aneurysm. This can lead to worsening AAA and ultimately rupture.		*Endoleaks- Vascular flow outside of the graft that is still contained in the aortic aneurysm. This can lead to worsening AAA and ultimately rupture.
	**Type 1- the seal of the graft fails		**Type 1: the seal of the graft fails
	**Type 2- a collateral vessel leaks		**Type 2: a collateral vessel leaks
	**Type 3- graft tear or failure		**Type 3: graft tear or failure
	**Type 4- porosity of the graft		**Type 4: porosity of the graft
	**Type 5- endotension/unidentifiable source		**Type 5: endotension/unidentifiable source
	*Limb ischemia- via embolism from the graft		*Limb ischemia- via embolism from the graft
	*Graft thrombosis~~-this~~ usually occurs in the first 6 months following graft implantation		*Graft thrombosis
	*Graft infection~~- a~~ rare complication but with a mortality approaching 40%. Symptoms are non-specific.		**This usually occurs in the first 6 months following graft implantation
			*Graft infection
			**A rare complication but with a mortality approaching 40%. Symptoms are non-specific.
	*Renal artery occlusion		*Renal artery occlusion
	*Colonic ischemia		*Colonic ischemia

Rossdonaldson1: /* Differential Diagnosis */

2020-08-05T23:04:13Z

Differential Diagnosis

← Older revision		Revision as of 23:04, 5 August 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	*complications unique to EVAR		===EVAR Complications===
	**Aortoenteric Fistula (most common)- expect symptoms of GI bleeding.		*Aortoenteric Fistula (most common)- expect symptoms of GI bleeding.
	**Endoleaks- Vascular flow outside of the graft that is still contained in the aortic aneurysm. This can lead to worsening AAA and ultimately rupture.		*Endoleaks- Vascular flow outside of the graft that is still contained in the aortic aneurysm. This can lead to worsening AAA and ultimately rupture.
	***Type 1- the seal of the graft fails		**Type 1- the seal of the graft fails
	***Type 2- a collateral vessel leaks		**Type 2- a collateral vessel leaks
	***Type 3- graft tear or failure		**Type 3- graft tear or failure
	***Type 4- porosity of the graft		**Type 4- porosity of the graft
	***Type 5- endotension/unidentifiable source		**Type 5- endotension/unidentifiable source
	**Limb ischemia- via embolism from the graft		*Limb ischemia- via embolism from the graft
	**Graft thrombosis-this usually occurs in the first 6 months following graft implantation		*Graft thrombosis-this usually occurs in the first 6 months following graft implantation
	**Graft infection- a rare complication but with a mortality approaching 40%. Symptoms are non-specific.		*Graft infection- a rare complication but with a mortality approaching 40%. Symptoms are non-specific.
	**Renal artery ~~Occlusion~~		*Renal artery occlusion
	**Colonic ischemia		*Colonic ischemia
	**Spinal cord ischemia		*Spinal cord ischemia

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Background */

2020-08-05T22:55:10Z

Background

← Older revision		Revision as of 22:55, 5 August 2020
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	==Background==		==Background==
	Patients with Endovascular Aortic Repair (EVAR) can have unique complications that are not discussed in most emergency medicine literature. EVAR has largely replaced open aortic repair as the gold standard for the treatment of Abdominal Aortic Aneurysm (AAA). Common complications including aortoenteric fistula, endoleaks, and graft thrombosis can present in a similar fashion to other common ED diagnoses~~. Understanding these complications can guide treatment and disposition of these patients~~.		[[File:Aneurysm endovascular.jpg\|thumb\|Endovascular aneurysm repair procedure]]
			*Patients with Endovascular Aortic Repair (EVAR) can have unique complications that are not discussed in most emergency medicine literature.
			*EVAR has largely replaced open aortic repair as the gold standard for the treatment of Abdominal Aortic Aneurysm (AAA).
			*Common complications including aortoenteric fistula, endoleaks, and graft thrombosis can present in a similar fashion to other common ED diagnoses.

	==Clinical Features==		==Clinical Features==

Salamis04: /* Management */

2020-08-02T23:11:56Z

Management

← Older revision		Revision as of 23:11, 2 August 2020
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	==Management==		==Management==
	*Coordination of care with vascular surgery is recommended when a graft issue is suspected- consult early		*Coordination of care with vascular surgery is recommended when a graft issue is suspected- consult early
	*~~balanced~~ resuscitation and early antibiotics if infection is suspected.		*Balanced resuscitation and early antibiotics if infection is suspected.

	==Disposition==		==Disposition==

Salamis04: /* Disposition */

2020-08-02T23:10:45Z

Disposition

← Older revision		Revision as of 23:10, 2 August 2020
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	==Disposition==		==Disposition==
	* Knowing the unique complications of EVAR is the first and most important step in the management of these patients.		* Knowing the unique complications of EVAR is the first and most important step in the management of these patients.
	* Unfortunately, while CT is sensitive for most complications of EVAR it does NOT definitively exclude Aortoenteric Fistula, Graft infection or endoleaks. Maintain a high index of suspicion ~~and~~ when a EVAR issue is suspected always lean toward conservative management ~~and~~ early specialist consultation.		* Unfortunately, while CT is sensitive for most complications of EVAR it does NOT definitively exclude Aortoenteric Fistula, Graft infection or endoleaks. Maintain a high index of suspicion when a EVAR issue is suspected and always lean toward conservative management/early specialist consultation.

	==See Also==		==See Also==

Salamis04: /* Differential Diagnosis */

2020-08-02T23:09:19Z

Differential Diagnosis

← Older revision		Revision as of 23:09, 2 August 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	*complications unique to EVAR		*complications unique to EVAR
	**Aortoenteric Fistula (most common)- expect symptoms of GI bleeding. ~~May be brisk or~~		**Aortoenteric Fistula (most common)- expect symptoms of GI bleeding.
	**Endoleaks- Vascular flow outside of the graft that is still contained in the aortic aneurysm. This can lead to worsening AAA and ultimately rupture.		**Endoleaks- Vascular flow outside of the graft that is still contained in the aortic aneurysm. This can lead to worsening AAA and ultimately rupture.
	***Type 1- the seal of the graft fails		***Type 1- the seal of the graft fails

Salamis04: /* Differential Diagnosis */

2020-08-01T22:33:51Z

Differential Diagnosis

← Older revision		Revision as of 22:33, 1 August 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	*complications unique to EVAR		*complications unique to EVAR
	**Aortoenteric Fistula (most common)		**Aortoenteric Fistula (most common)- expect symptoms of GI bleeding. May be brisk or
	**Endoleaks		**Endoleaks- Vascular flow outside of the graft that is still contained in the aortic aneurysm. This can lead to worsening AAA and ultimately rupture.
	**Limb ischemia		***Type 1- the seal of the graft fails
	**Graft thrombosis		***Type 2- a collateral vessel leaks
	**Graft infection		***Type 3- graft tear or failure
			***Type 4- porosity of the graft
			***Type 5- endotension/unidentifiable source
			**Limb ischemia- via embolism from the graft
			**Graft thrombosis-this usually occurs in the first 6 months following graft implantation
			**Graft infection- a rare complication but with a mortality approaching 40%. Symptoms are non-specific.
	**Renal artery Occlusion		**Renal artery Occlusion
	**Colonic ischemia		**Colonic ischemia

Salamis04: /* References */

2020-08-01T22:26:49Z

References

← Older revision		Revision as of 22:26, 1 August 2020
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	==References==		==References==
	<references/>		<references/>
			* Slama R, Long B, Koyfman A,: The Emergency medicine approach to abdominal vascular graft complications. AJEM 2016; 34: pp. 2014-2017
	[[Category:Surgery]]		[[Category:Surgery]]

Salamis04: /* Disposition */

2020-08-01T22:22:17Z

Disposition

← Older revision		Revision as of 22:22, 1 August 2020
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	==Disposition==		==Disposition==
			* Knowing the unique complications of EVAR is the first and most important step in the management of these patients.
			* Unfortunately, while CT is sensitive for most complications of EVAR it does NOT definitively exclude Aortoenteric Fistula, Graft infection or endoleaks. Maintain a high index of suspicion and when a EVAR issue is suspected always lean toward conservative management and early specialist consultation.

	==See Also==		==See Also==