Complications

in Endovascular Trauma Management

Applied

Type

Addition

Confidence

90%

Created

Mar 27, 2026

Evidence

2 sources

Rationale

The integration adds the gold-standard Clavien-Dindo classification for complication grading, which is essential for any surgical textbook section on complications. It also incorporates a very recent (2024) review specifically focused on REBOA complications to ensure the content reflects the most current literature. All abbreviations were expanded on first use as per the instructions, and the existing structure and citations were preserved.

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;9(1):e001267. 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-e]. Standardized reporting and grading of these events using the Clavien-Dindo classification is recommended to facilitate objective outcome analysis and quality improvement [@dindo2026-c].

<!-- 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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