No surgery is without risk. TEVAR may be a minimally invasive (key hole) procedure, but it is associated with manipulation of the aorta and may therefore have potentially serious complications including death. Complications of surgery can broadly be categorised according to when they occur (during the hospital admission - early, or following discharge - late) and whether or not they occur at the site of surgery (local) or affect the entire body (systemic). Some possible complications of TEVAR include; •Early complications: •Local oWound related - Bleeding - Infection - Wound breakdown - Fluid collection oInjury to surrounding structures - Nerve damage causing numbness, pain or weakness in the leg - Lymphatic leak causing leakage from the wound, collection or leg swelling - Ascending aortic dissection oGraft complications: - Bleeding or blockage requiring re-operation. - Graft infection (rare) oBlood clot in leg (deep vein thrombosis) •Systemic oHeart related - Heart attack - Irregular heart rhythm oLung related - Pneumonia - Fluid on the lungs - Clot on the lung (pulmonary embolus) oKidney related - Kidney failure that may require temporary dialysis oBrain related - Stroke oSpinal cord related - Spinal cord ischemia: This is caused by exclusion of small arteries supplying the spinal cord that arise from the aorta in the chest and abdomen. Inadequate perfusion of the spinal cord leads to nerve dysfunction and potentially paraplegia. Your team assess the risk of this complication pre-operatively by taking into account factors known to contribute to spinal cord ischaemia, such as extent of stentgraft aortic coverage, and patency of pelvic (internal iliac) or left shoulder (subclavian) arteries. If you are felt to be at a high risk for this complication your surgeons may opt to insert a spinal cord drain prior to surgery to improve cord perfusion in the operative and peri-operative period. •Late complications •Stent graft blockage: oBlockage of (a limb of) the stent graft is a rare occurrence. It is seen in 0-5% of TEVAR cases. This may be precipitated by stent graft kinking or narrowing/blockages of blood vessels upstream or downstream of the stent graft. The indication for treatment depends on the severity of associated symptoms, the physical condition of the patient and the vascular anatomy. If possible, endovascular (key hole) procedures are used to restore blood flow through the graft, although occasionally a bypass operation may have to be carried out. •Endoleak: oPersistent blood flow in the aneurysm sack after endovascular repair is defined as an endoleak and is considered a complication of the procedure as the primary objective of endovascular aneurysm repair is to exclude the aneurysm sack from the circulation. Depending on the nature of the endoleak, the persistent blood flow in the aneurysm sack means that the sack may still be pressurised and therefore likely to rupture. Endoleaks caused by holes in the graft material, insufficient apposition of the stent graft against the aortic wall in the landing zone or disconnection of overlapping stent graft components require intervention in order to depressurize the aneurysm sack and mitigate the risk of rupture. These endoleaks may be related to poor placement of the stent graft, graft material failure, graft migration or progression of aneurysmal disease. Lifelong surveillance is necessary to mitigate the risk associated with these endoleaks which develop in as many as 20-40% of patients during long term follow up. Alternatively, retrograde flow of blood through aortic side branches such as the intercostal arteries, into the aneurysm sac are innocuous and do not require any treatment. All these potential complications are understandably concerning. Rest assured our surgeons make every effort to ensure your risk is reduced to the lowest level possible through our expertise and experience. The overall risk of you suffering from a major complication that either threatens your life or leg is about 2%. When complications do occur we deal with them rapidly and appropriately.