Vascular problems in urologic patients

Intraoperative vascular surgical consultation may be necessary if venous or arterial injury occurs during transabdominal urologic operations. Loss of blood usually can be controlled by simple digital compression until the consultant arrives, but urologists should be familiar with the principles of vascular reconstruction. Adequate exposure of the injured segment is essential, and the repair of major vessels must preserve patency as well as provide hemostasis. In this regard, patch angioplasty is sometimes necessary, and formal replacement with autogenous or prosthetic grafts may rarely be required. Blunt arterial trauma can precipitate distal arterial embolization, a complication that usually is not suspected until the immediate postoperative period. Although salvage should be managed by a vascular surgeon, urologists must be alert for the early signs of acute extremity ischemia after extensive retraction has been used deep in the pelvis, particularly in elderly or atherosclerotic patients. Considering the established diagnostic accuracy of roentgenographic studies presently employed in the fields of urology and vascular surgery, preoperative planning should limit the number of urgent intraoperative consultations between members of these two specialties. Each may have valuable advice to offer the other concerning the treatment of unusual problems involving obstructive uropathy, aortic aneurysms, and occlusive arterial disease, and their cooperative effort is especially important in the management of renal revascularization.