Ver el código de «Aortic endograft complications»

==Background==
[[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==
The presentation can vary based on the underlying issue with the graft. Most symptoms are non-specific and include nausea, vomiting, abdominal pain, hematochezia, and back pain.

==Differential Diagnosis==
===EVAR Complications===
*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.
**Type 1: the seal of the graft fails
**Type 2: a collateral vessel leaks
**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
*Colonic ischemia
*Spinal cord ischemia

==Evaluation==
*Physical
**There are no exam findings which reliably rule in or out these diagnoses.
*Labs
**CBC, CMP, Lipase, Type and Screen, UA, +/- Blood cultures(graft infection), +/- Lactate(suspected mesenteric ischemia)
*Imaging
**CT- for the highest sensitivity a '''triple phase CT scan (non-contrast, arterial phase, delayed phase)''' is required. Usually you want to talk with radiology prior to this study.
**Ultrasound- both point of care ultrasound and duplex ultrasound do not detect EVAR complications with high enough sensitivity to be use routinely.

==Management==
*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.

==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 when a EVAR issue is suspected and always lean toward conservative management/early specialist consultation.

==See Also==
*[[Post-surgical complications]]

==External Links==


==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]]