Acute Testicular Ischemia following Endovascular Abdominal Aortic Aneurysm Repair Identified in the Emergency Department

Abstract

Endovascular aneurysm repair (EVAR) is perhaps the most widely utilized surgical procedure for patients with large abdominal aortic aneurysms. This procedure is minimally invasive and reduces inpatient hospitalization requirements. The case involves a 72-year-old male who presented to the emergency department with right testicular ischemia two days following EVAR. Given the minimal inpatient hospitalization associated with this procedure, emergency physicians are likely to encounter associated complications. Ischemic and thromboembolic events following EVAR are extremely rare but require prompt vascular surgery intervention to minimize morbidity and mortality.

Post-endovascular aneurysm repair (EVAR) testicular ischemia: A rare complication

“…Ischemic complications range from intermittent claudication to ischemic necrosis requiring amputation. Testicular ischemia is a rarely reported complication with only three reported cases in the literature 2, 3. One case report from 2010 reported testicular ischemia, for which the patient underwent orchiectomy 2 .…”

“…One case report from 2010 reported testicular ischemia, for which the patient underwent orchiectomy 2 . Another case report from 2014 reported testicular ischemia following EVAR which was managed conservatively with symptom control, after which the patient recovered 3 . The mechanism of testicular ischemia following EVAR is not known.…”

“…Current theories include thromboembolic events, absence of collateral blood flow, delayed occlusion of testicular arteries, or graft migration as possible causes. The onset of testicular pain in previous studies has ranged from two days to six weeks after surgery 2, 3. Additionally, the presenting symptoms included groin pain, flank pain, and/or testicular pain 2, 3.…”

A Case of Orchiectomy after Femoral Artery PTA

“…Testicular ischemia is a rarely complication with only four cases till now reported in the literature [3][4][5][6]. After lowerlimb peripheral PTA, the ischemic complications range from intermittent claudication to ischemic necrosis requiring re-PTA, or surgical bypass, or amputation.…”

“…However, the testicular infarction caused by extrinsic compression is a very rare complication of percutaneous procedures. In literature, only four cases of testicular ischemic necrosis are described [3][4][5][6], but a giant hematoma with serious stuffing of the spermatic cord and the testis has been never reported.…”