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The emergency medicine approach to abdominal vascular graft complications

The diagnosis and management of AAA is a concept well embedded in emergency medicine (EM) literature. Little literature exists that addresses the potential complications after EVAR. Patients undergoing EVAR can have postoperative complication rates approximating 30%. Even nonspecific presentations such as abdominal pain, hematuria, flank pain, or syncope may be a warning sign of graft complication. Although multiple studies are present in vascular surgery and interventional radiology literature, few studies exist in EM literature.

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 Abdominal Vascular Graft Complications

There are many complications that can occur from having an aortic graft placed, but for the purpose of this article let’s focus on Aortoenteric fistula and Endoleaks.

Articles of Interest

Complications of endovascular aneurysm repair of the thoracic and abdominal aorta: evaluation and management

EVAR is increasingly being used for the treatment for thoracic and AAAs and certain other aortic pathologies. It is minimally-invasive, is associated with decreased perioperative morbidity and conveys a short-term survival advantage when compared to open surgical repair. One of the disadvantages of EVAR is the relatively high incidence of post-procedural complications that thus necessitates lifelong imaging surveillance of patients. CT is the preferred method for post-procedural imaging surveillance. A number of patients require secondary re-interventions to address post-procedural endograft-related complications. Most re-interventions are pursued using an endovascular approach. With the increasing number of endovascular repair procedures performed, it is important for clinicians to gain familiarity with common complications and treatment strategies following this procedure.

Complications of EVAR

Like all endovascular procedures, EVAR shares a common set of complications related to the actual interventional procedure and graft deployment. Patients undergoing EVAR are at risk for renal deterioration related to several potential mechanisms.

Detection of Late Complications After Endovascular Abdominal Aortic Aneurysm Repair

Endovascular aortic aneurysm repair (EVAR) is the primary technique for treatment of abdominal aortic aneurysms in most countries.1,2 Compared with open aneurysm repair, EVAR is minimally invasive, requires a shorter hospital stay and results in less blood loss as well as faster recovery. Additionally, EVAR has a significant short term survival benefit compared with open repair. On the other hand EVAR is associated with a non-negligible risk of endograft failure and rupture over time, which mandates continuous surveillance and timely selective re-intervention.