SDTI development may not be a nEVAR event: A Case study presentation of SDTI development in a Vascular Surgery patient

The endovascular repair of Abdominal Aortic Aneurysm (EVAR) that involves embolization of the internal iliac artery is becoming more common. EVAR has the potential for sacral-coccyx complications from the interruption of blood flow to the pelvic area. It is theorized EVAR patients have a higher incidence of suspected deep tissue injury (SDTI) than other patients undergoing surgical procedures using standard preventative measures.

A vascular surgery patient underwent an elective, staged EVAR utilizing a modified approach. The patient had multiple comorbidities including Buerger’s disease with bilateral lower extremity amputations.  Complications resulted in the patient’s return to the operating room seven times with total procedure time of twenty hours in eight days. The WOCN Consult service recommended a plan of care to address the developing sacral-coccyx SDTI and the worsening of the lower extremity stump incisions. The patient was on a low air loss surface with documented turning every two hours by the ICU nursing staff, had self-adherent silicone border foam dressing to the sacrum, and was receiving parenteral nutrition. Despite these measures, the SDTI that covered the sacral-coccyx continued to worsen. A multidisciplinary discussion examined factors that contributed to the development of the SDTI and stump incision deterioration. Evidence pointed toward loss of perfusion when the internal iliac artery was embolized. It is believed from the discussion that an unavoidable situation due to significant loss of perfusion altered the patient’s tissue tolerance and brought about the SDTI despite adherence to standard preventative measures.

There is a lack of nursing literature to support the development of an unavoidable sacral-coccyx pressure ulcer following EVAR. Medical literature describes the complication and potential solution to preserve the internal iliac artery. Nursing research is needed to determine whether SDTI is an unavoidable outcome of EVAR.