Complications

in Endovascular Trauma Management

Applied

Type

Addition

Confidence

90%

Created

Mar 27, 2026

Evidence

2 sources

Rationale

The section was updated to include the standard Clavien-Dindo classification for complications, which is essential for academic surgical texts. Additionally, a 2024 review on REBOA complications was used to reinforce the existing structure and add Acute Kidney Injury (AKI) to the complications table, as it is a major systemic risk of aortic occlusion. All abbreviations (CFA, REBOA, DCR, AKI) were expanded on first use within the section as per instructions.

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
Ribeiro Junior MAF, et al. Complications associated with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA): an updated review. Trauma Surg Acute Care Open. 2024. PMID: 38347890.
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.thrombosis/infection [@marcelo2024-d]. To ensure standardized reporting and quality improvement, complications should be graded using the Clavien-Dindo classification system [@dindo2026-b].

<!-- 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 REBOA (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 |
| Acute kidney injury (AKI) | Prolonged suprarenal (Zone I) occlusion | Optimize renal perfusion; minimize nephrotoxic agents; monitor urine output. [@marcelo2024-d] |
| 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]
Go to section in textbookDispute / Submit evidenceAll updates