Risk factors for ischemic complications in vascular reconstructive surgeries

Area of Science:

• Neurosurgery
• Vascular Surgery
• Neurology

Background:

• Postoperative ischemic complications are a known risk in vascular reconstructive surgery.
• Analyzing causes is challenging due to variable factors like lesions, techniques, and perioperative treatments.

Purpose of the Study:

• To analyze the causes of ischemic complications in vascular reconstruction surgeries.
• To identify risk factors for symptomatic and asymptomatic cerebral ischemia in a standardized surgical setting.

Main Methods:

• Retrospective review of 66 patients (24 aneurysm, 42 ischemic disease) undergoing vascular reconstruction between 2008-2018.
• Postoperative cerebral ischemia assessed via MRI-DWI within 4 days.
• Statistical analysis of clinical and treatment factors associated with ischemia.

Main Results:

• Symptomatic ischemia occurred in 3 cases (all aneurysms); asymptomatic in 8 cases.
• Risk factors for symptomatic ischemia included clipping and aneurysms; preoperative antithrombotic therapy showed a protective association.
• Asymptomatic ischemia was associated with aneurysms and radial artery grafts (RAGs).

Conclusions:

• Vascular reconstruction for cerebral aneurysms can be safe, but complications may relate to aneurysmal occlusion procedures.
• Preoperative antithrombotic therapy is advisable.
• Caution is needed for asymptomatic cerebral ischemia, especially with RAGs.