EMCrit 297 – EVARs, TEVARs, and Endoleaks – Oh My! with Ani Aydin - a podcast by Scott D. Weingart, MD FCCM

EndoVascular Aortic Repairs are a game changer in patients with AAAs. Add a T and you get a TEVAR for the treatment of aortic dissections. Despite the amazing advances that these devices represent, they are not without problems.

Ani Aydin, MD

Dr. Aydin is an assistant professor of emergency medicine at Yale EM. She received her medical degree from Stony Brook Medicine, did EM residency at Bellevue/NYU, and then completed a fellowship in surgical critical care at the Shock Trauma Center (we bleed pink, yay!!). She is the medical director of the Yale critical care transport service. Her academic work includes projects ranging from mechanical ventilation to endovascular emergencies.

Recently Done Operation

Look at the Access Site in the groin. These devices require enormous access in the femoral vessels. Search for pseudoaneurysms, dissection, thrombosis, or bleeding.



Kidney injury both from operation and all of the imaging that goes along with it

Endoleaks

Leaks through or around the graft into the original aneurysm.



Get imaging. Don't get ad hoc imaging. They need specialized CT angiography of the chest and abdomen with both arterial phase and delayed venous phase. You really want to work the scan parameters out ahead of time with your radiologists.



* Type 1: Failure of complete apposition to vessel wall (1a is proximal, 1b is distal)

* Type 2: Retroleak - Back flow through a vessel

* Type 3: Graft torn or ruptured

* Type 4: Porosity of the graft

* Type 5: Unclassified/Who Knows?



from UW Emerg Radiology



Type 1 and Type 3 needs immediate surgical intervention



for the others, Aortic dp/dt control just like a dissection until you get in touch with Vascular

Thrombosis and Embolus

These pts can through clots to their distal vessels



Look for arterial clots and for mesenteric ischemia

Reach out to the Patient's Vascular Surgeon

anytime someone has any issue with their EVAR, call early!!!!

Review Article



* Aortic graft emergencies



Other Great FOAM



* EM Docs on EVAR Complications



Now on to the Podcast...

Further episodes of EMCrit Podcast

Further podcasts by Scott D. Weingart, MD FCCM

Website of Scott D. Weingart, MD FCCM