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EMCrit 297 – EVARs, TEVARs, and Endoleaks – Oh My! with Ani Aydin
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...
View all episodes
By Scott D. Weingart, MDEndoVascular 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...