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Updated: Mar 2, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Infrainguinal open reconstruction: a review of surgical considerations and expected outcomes
Sevan R Komshian1, Kimberly Lu1, Steven L Pike1
1Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA, USA.
Insights
Open reconstruction for infrainguinal arterial occlusive disease is crucial but carries risks. Careful patient selection and risk assessment are vital to minimize complications and optimize outcomes for limb salvage.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Arterial Disease Management
Background:
- Infrainguinal arterial occlusive disease presents significant limb-threatening risks.
- Revascularization is indicated for symptoms like claudication, rest pain, or tissue loss.
- Open surgical reconstruction remains a key treatment despite advances in endovascular techniques.
Purpose of the Study:
- To review clinical indications for open infrainguinal reconstruction.
- To detail the perioperative morbidity and mortality associated with these procedures.
- To emphasize the importance of risk stratification in patient selection.
Main Methods:
- Literature review of open reconstruction techniques for infrainguinal arterial occlusive disease.
- Analysis of clinical indications for surgical intervention.
- Compilation of data on local and systemic postoperative complications.
Main Results:
- Open reconstruction is associated with local complications (surgical site infections, graft failure, amputation) and systemic issues (cardiac, respiratory, renal, neurovascular, thromboembolic).
- Specific complication rates range widely, highlighting the need for careful management.
- Individualized candidate selection is essential, balancing intervention need against potential adverse outcomes.
Conclusions:
- Careful preoperative assessment and risk stratification can help minimize postoperative morbidity.
- Optimizing patient selection for open infrainguinal reconstruction is critical for successful outcomes.
- Understanding perioperative risks is key to managing patients undergoing open arterial reconstruction.
Abstract:
Infrainguinal arterial occlusive disease can lead to potentially disabling and limb-threatening conditions. Revascularization may be indicated for claudication, rest pain, or tissue loss. Although endovascular interventions are becoming more prevalent, open surgeries such as endarterectomy and bypass are still needed and performed regularly. Open reconstruction has been associated with postoperative morbidity, both at the local and at the systemic levels. Local complications include surgical site infections (SSIs 0-5.3%), graft failure (12-60%), and amputation (5.7-27%), and more systemic issues include cardiac (2.6-18.4%), respiratory (2.5%), renal (4%), neurovascular (1.5%), and thromboembolic (0.2-1%) complications. While such outcomes present an additional challenge to the postoperative management of surgical patients, it may be possible to minimize their occurrence through careful risk stratification and preoperative assessment. Therefore, individualized selection of candidates for open repair requires weighing the need for intervention against the likelihood of adverse outcomes based on preoperative risk factors. This review provides an overview of open reconstruction, focusing on identifying the clinical indications for surgery and perioperative morbidity and mortality.
