Failure of peripheral arterial reconstruction

Infrainguinal arterial reconstruction utilizing autogenous vein grafts provides acceptable results in most cases, yet 15-25% of such grafts fail during the first 5 years. Secondary reconstruction, especially when vein graft failure is identified prior to total thrombosis, frequently restores significant patency although multiple attempts may be required. While the reasons for initial graft failure are understood in many cases, a significant number of early failures occur within 30 days without a specific cause being determined. While the in situ technique combined with completion angiography has reduced the incidence of these early failures, in order to effect further reductions, surgical and anesthetic management must address such diverse entities as vasospasm, hypercoagulopathy, embolization, and systemic hypotension.