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Complications of major aortic and lower extremity vascular surgery

J Nana Ghansah1, J Thomas Murphy

  • 1Department of Anesthesiology, University of Kentucky, College of Medicine, H A Chandler Medical Center, Lexington, KY 40536-0293, USA.

Seminars in Cardiothoracic and Vascular Anesthesia
|December 8, 2004
PubMed

Insights

This review covers complications of open aortic repair and endovascular aortic repair (EVAR). EVAR shows promise for fewer complications, but carries unique risks like endoleaks and requires ongoing surveillance.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology

Background:

  • Atheromatous disease of the aortoiliac and distal arteries necessitates invasive interventions.
  • Patient risk factor management has improved outcomes, but complications remain significant across organ systems.
  • Cardiovascular complications, infection (aortoenteric fistula), paraplegia, and multiorgan failure are serious risks of open repair.

Purpose of the Study:

  • To review perioperative and postoperative complications associated with open aortic repair and lower-extremity revascularization.
  • To examine endovascular aortic repair (EVAR), its unique complications, and compare it to open repair.
  • To discuss anesthesia considerations for major vascular surgery and EVAR, including acute abdominal aortic aneurysm management.

Main Methods:

  • Review of perioperative and postoperative complications of open aortic repair and lower-extremity revascularization.
  • Review of endovascular aortic repair (EVAR) technology, its development, and associated complications.
  • Discussion of anesthesia-related concerns for both open and endovascular procedures.

Main Results:

  • Open repair and vascular surgery for infrainguinal disease carry significant risks, including cardiovascular events and organ damage.
  • EVAR, a hybrid surgical and radiological intervention, presents similar complications to open repair but potentially less frequently.
  • Unique EVAR complications include endoleaks, endoprosthesis migration, and need for surgical conversion; potential benefits include reduced blood loss and hospitalization.

Conclusions:

  • EVAR offers potential advantages over open repair, but risks such as aneurysm recurrence and the need for prolonged surveillance and secondary procedures exist.
  • Understanding and managing complications, including anesthesia-related issues, is crucial for both open and endovascular aortic interventions.
  • EVAR represents an evolving technology with specific challenges and benefits that require careful consideration in patient management.

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