Complications

in Endovascular Trauma Management

Applied

Type

Addition

Confidence

95%

Created

Mar 26, 2026

Evidence

1 source

Rationale

The integration of the Clavien-Dindo classification (Dindo 2026/2004) is essential for any modern surgical textbook section on complications, as it provides the standard language for reporting and grading adverse events. I also expanded all required abbreviations (CFA, pREBOA, iREBOA, DCR) on their first use within this section to comply with the formatting rules while preserving the existing structure and citations.

Evidence

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. PMID: 15273542.
Verified source
PubMedDOI

Content Changes

<!-- type: complications -->

Complications of endovascular trauma management (EVTM) arise from (1) large-bore access, (2) ischemia–reperfusion during occlusion, and (3) device-related thrombosis/infection. To facilitate objective comparison and quality assessment, complications should be categorized using standardized systems such as the Clavien-Dindo classification [@dindo2026-classification].

<!-- type: checklist -->

**Complication prevention bundle**

- **Access safety:** ultrasound-guided CFAcommon femoral artery (CFA) puncture; avoid high/low sticks; use smallest feasible sheath. [@bulger2019]
- **Time discipline:** define a definitive control destination before inflation; minimize total occlusion time. [@bulger2019]
- **Occlusion strategy:** consider pREBOA/iREBOApartial resuscitative endovascular balloon occlusion of the aorta (pREBOA) or intermittent REBOA (iREBOA) when prolonged bridging is unavoidable and expertise exists. [@sadeghi2018-partial]
- **Post-occlusion readiness:** communicate before deflation; anticipate acidosis/hyperkalemia/hypotension and treat proactively within DCR.damage control resuscitation (DCR). [@spahn2019]

<!-- type: table -->

**Table 16.6. Common EVTM Complications and Immediate Responses**

| **Problem** | **Typical cause** | **Immediate response** |
| --- | --- | --- |
| CFA dissection/thrombosis | Large sheath, poor puncture site | Maintain wire access; angiography; repair/covered stent vs open repair |
| Limb ischemia | Sheath occlusion, prolonged Zone III occlusion | Reduce sheath size if possible; consider distal perfusion strategy; monitor compartments |
| Severe metabolic derangement at deflation | Prolonged occlusion | Staged deflation; treat hyperkalemia/acidosis; vasopressors as bridge |
| Stent thrombosis | Low flow, inadequate antithrombotic plan | Restore flow; individualized antithrombotic strategy after hemostasis |
| Endograft infection | Contamination/bacteremia | Early suspicion; antibiotics; consult vascular/infectious disease; consider explant in selected cases. [@esvsvgei2020] |

Cross-reference: [[resuscitative endovascular balloon occlusion of the aorta (REBOA)]] and [[Massive Transfusion]]. [@bulger2019] [@spahn2019]
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