Testicular ischaemia: one of the most unknown of post-EVAR complications

Abstract

Testicular ischaemia after endovascular aortic aneurysm repair (EVAR) is a very uncommon complication. There are only a few cases reported in the literature and the pathogenesis remains unclear. We report a case of unilateral testicular ischaemia in the early postoperative period after EVAR.A 78-year-old man underwent standard EVAR without immediate complications. Twenty-four hours after the procedure, the patient developed sudden onset of right scrotal pain and a low-grade fever. Urgent testicular ultrasound showed ischaemic signs compromising 75% of the testicle. The patient was successfully managed with conservative treatment.Although the pathogenesis is unknown, acute thrombosis of the testicle feeding arteries is postulated as the main hypothesis in the physiopathogenesis.

Acute global testicular infarction: A rare and important complication after endovascular abdominal aortic aneurysm repair

“…In the absence of global testicular infarction, conservative medical treatment with nonsteroidal anti-inflammatory drugs has been reported to be effective. 1 , 2 , 3 , 4 …”

“…The testicular arteries arise directly from the infrarenal aorta and serve as the primary blood supply to the testes, supplying 80% of the testicular volume. 2 The cremasteric artery, a branch of the inferior epigastric artery, provides only minimal blood flow to the testicular parenchyma. The deferential artery is a branch of the inferior vesicle artery that originates from the internal iliac artery.…”

“…It primarily supplies the epididymis and vas deferens but also anastomoses with branches of the testicular artery within the testis, supplying nearly 20% of the testicular volume. 2 A study using an injection-corrosion casting technique to establish a three-dimensional topography of the testis showed that all examined testes had testicular, deferential, and cremasteric arteries with clear anastomotic communications between the three. 13 Given this collateral network, occlusion of the testicular artery by the stent graft during EVAR should not typically lead to symptomatic testicular ischemia.…”

“…Testicular ischemia after endovascular abdominal aortic aneurysm repair (EVAR) is emerging as a rare, but serious, complication. To the best of our knowledge, there have been only 12 cases of post-EVAR testicular ischemia reported worldwide, 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 and this is the fourth case reported in the United States. 3 , 4 , 6 , 9 This report aims to highlight the importance of early recognition of this complication and contribute to our understanding of its pathophysiology.…”