Endovascular Stent-Grafts
Type
ModificationConfidence
92%
Created
Apr 15, 2026
Evidence
1 source
Rationale
The ESVS 2026 guidelines (PMID 41448425) directly supersede the Riambau 2017 ESVS guidelines for the claim supporting endovascular-first strategies in BTAI. Per the stale guideline replacement instructions, riambau 2017 has been replaced with European Society for Vascular Surgery (ESVS) for this claim rather than co-citing both. The US guideline Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al is retained to maintain geographic balance. No other content changes are warranted as the new article does not introduce materially different claims beyond what is already covered in the section.
Evidence
These 2025 ESVS clinical practice guidelines provide comprehensive and up to date advice to physicians and patients on the management of diseases of the mesenteric and renal arteries and veins.
Content Changes
<!-- type: treatment --> Covered stents and stent-grafts are core endovascular trauma management (EVTM) tools for **rapid hemorrhage control with preservation of in-line flow**, especially in anatomically hostile or unstable scenarios where open exposure is slow or morbid. [@markov2011] <!-- type: comparison --> **Table 16.4. Endovascular Stent-Grafts in Trauma (Practical Use)** [@markov2011] | **Injury Pattern** | **Endovascular Option** | **Advantages** | **Key Constraints** | | --- | --- | --- | --- | | Blunt thoracic aortic injury (BTAI) | **thoracic endovascular aortic repair (TEVAR)** | Avoids thoracotomy; rapid exclusion | Landing zones, arch anatomy, coverage planning | | Subclavian/axillary disruption | Covered stent | Junctional control; avoids difficult exposure | Infection risk if contaminated field | | Iliac artery disruption | Covered stent/stent-graft | Hemostasis + flow preservation | May require antiplatelet therapy | | Carotid/vertebral injury (selected) | Covered stent (highly selected) | Maintains cerebral perfusion | Stroke/antithrombotic balance; contamination | **Traumatic thoracic aorta** Endovascular repair is widely used for BTAI in appropriately selected patients, with guideline support for endovascular-first strategies when anatomy permits. [@riambau2017][@esvs2025] [@isselbacher2022] **Antithrombotic and infection considerations** - Trauma patients may have competing bleeding risks; antiplatelet/anticoagulation plans must be individualized and revisited after hemostasis. - Stent-graft infection is uncommon but catastrophic; contamination, bowel injury, and prolonged bacteremia increase concern. [@esvsvgei2020] **Post-procedure surveillance** When feasible, arrange follow-up imaging (computed tomography angiography (CTA) or duplex depending on vascular bed and device) to detect endoleak, stenosis, or thrombosis (practice varies by territory). See [[Aortic Disease]] and [[Follow-up After Endovascular Repair]]. [@isselbacher2022]