Consent: Endovascular Abdominal Aortic Aneurysm Repair - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure An endovascular abdominal aortic aneurysm repair involves introducing a graft into the aorta via the femoral arteries and fixing a stent across the aneurysm. It creates a seal below the renal arteries, and in the iliac arteries, thus excluding the aneurysmal segment. The consent for Fenestrated EVAR, Branched EVAR, or Chimney EVAR would be the same, however with increased risk of morbidity and mortality, particularly a higher risk of renal failure and bowel ischaemia. US gov [Public domain] Figure 1Endovascular repair of an abdominal aortic aneurysm Intra-Operative Complications Complication Description Potential Ways to Reduce Risk Conversion to Open Repair There is an extremely small possibility that the stent cannot pass through the iliac arteries, or that the stent causes the aorta to rupture, necessitating either cessation of the procedure, or conversion to open repair. Nerve Injury The patient may notice a numb patch of skin around or below the groin incision due to damage to superficial nerves. Anaesthetic Risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation Early Complications Complication Description Potential Ways to Reduce Risk Pain Local anaesthesia will be used in the femoral incisions, however chronic pain from damage to the femoral nerve or its branches is possible. Bleeding There will be a small volume of blood lost during surgery. There is a small chance of bleeding and bruising in the groin post-surgery. Infection Superficial wound infection is possible, however graft infection if occurs is a major complication requiring life-long antibiotics and graft excision if possible. Chest infection is possible although less common in local anaesthetic procedures. Peri-operative antibiotics will reduce the risk of wound and graft infections Scarring Groin incisions will result in a scar, which may form a keloid scar, particular in high risk ethnicities. Seroma A swelling of lymphatic fluid may occur in the groin wounds due to disruption of the lymph nodes and channels. Blood Clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin to minimise this risk as deemed appropriate. Bowel Ischaemia The inferior mesenteric artery is occluded during the procedure. Collateral circulation from the superior mesenteric artery and coeliac axis will usually prevent this complication, however in cases of SMA or coeliac stenosis bowel ischaemia may occur. Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery Late Complications Complication Description Endoleak An incomplete seal of the aneurysm, whereby begins to blood leak around the graft (more detail found here) Migration Movement of the stent downwards thus disrupting the seal zone at the top of the graft, leading to a Type Ia endoleak. Limb occlusion A kink or narrowing in the stent limb can lead to occlusion and acute limb ischaemia, requiring thrombolysis, embolectomy, or a femoro-femoral crossover graft. Impotence An alteration in the blood supply to the pelvis can cause impotence Reintervention There is a 20% chance of a further operation to repair the endovascular stent-graft. This would be due to any of the complications listed above and is usually performed under local anaesthesia through the groin. Frequent questions What is endovascular abdominal aortic aneurysm repair? Endovascular abdominal aortic aneurysm repair is a minimally invasive procedure that involves placing a graft into the aorta through the femoral arteries to seal off an aneurysm. This technique aims to exclude the aneurysmal segment and maintain blood flow to the renal and iliac arteries. What are the potential intra-operative complications of endovascular aortic repair? Intra-operative complications may include conversion to open repair if the stent cannot pass through the iliac arteries, or if it causes an aortic rupture. Additionally, nerve injury may occur, leading to numbness around the groin incision, and anaesthetic risks can involve damage to the teeth or larynx and cardiovascular issues. What early complications should be monitored after endovascular abdominal aortic aneurysm repair? Early complications include pain at the incision site, bleeding, infection, scarring, seroma formation, and the risk of blood clots such as DVTs and PEs. Preventative measures like peri-operative antibiotics and anti-embolism stockings can help reduce these risks. What late complications can arise from endovascular abdominal aortic aneurysm repair? Late complications may involve endoleak, where blood leaks around the graft, stent migration affecting the seal, limb occlusion leading to acute ischaemia, impotence due to altered pelvic blood supply, and a 20% chance of requiring further surgical intervention. How does bowel ischaemia occur during endovascular abdominal aortic aneurysm repair? Bowel ischaemia can occur when the inferior mesenteric artery is occluded during the procedure, particularly if there is pre-existing stenosis in the superior mesenteric artery or coeliac axis. However, collateral circulation typically helps prevent this complication in most cases. Rate This Article