Editing EVAR (section)

= Complications =

* Endoleak (persistent blood entry into aneurysmal sac after EVAR). There is continued pressurisation of the sac - can lead to continued growth and rupture

*
* Type I: persistent blood flow into the sac either from around the graft proximally (IA) or distally (type IB)
** Late:
*** Typically secondary to caudad migration of the stent graft, or continued dilation of the neck
*** Proximal extension may be deployed to achieve a proximal seal
* Type II: persistent sac filling from back-bleeding side branches (IMA, lumbar arteries, middle sacral artery)
** Occurs in 10-20% of EVAR patients
** Relatively benign course - up to 80% resolve spontaneously within 6-12 months, with low risk of aneurysm rupture. No association between type II endoleak and risk of aneurysm rupture or need for surgical conversion.
** Typically not treated unless sac enlargement is documented.
** Embolisation can be performed using coils or glue - either via SMA or through sac
** If endovascular techniques fail, operative explant may be required
* Type III: fabric erosion or leak between the stent-graft components - occurs in modular components
** Effectively treated with re-lining
* Type IV - porosity of graft fabric
** Noted within 30 days of graft implantation
** No treatment usually required
* Type V: 'endotension' - elevated sac aneurysm pressure without a demonstrable endoleak
** Aetiology likely to be undetected endoleak or transmission of systemic pressure through thrombus

* Graft occlusion - limb thrombosis or kinking - 3%
** Claudication in buttock/thigh/calf
** Rest pain
** Acute ischaemia
** Mostly occurs early on
* Ischaemic complications
** Direct vessel occlusion by stent-graft, or occlusion of the stent-graft itself; atheroembolic events during catheter manipulation or device deployment; inadequate collateralisation of mesenteric or pelvic circulation
* Spinal cord ischaemia - 0.25%
** Dreaded complication, not really understood exactly why it happens
* AKI - common
* Late conversion to open - 1%
* Infection

[[Category:Vascular]]