Postoperative complications in vascular surgery

Abstract

The increase in numbers of vascular operations is due to a worldwide increase in vascular disease and diabetes. As a result of demographic changes, most of the vascular patients are comorbid and are therefore associated with multiple risk factors. Complications of vascular surgery can be divided into systemic, local non-vascular and vascular complications. Systemic complications are primarily caused by the patients' comorbidity. The prevalence of additional coronary heart disease and cerebral sclerosis accounts for approximately 40-60%, concomitant relevant stenoses of the renal arteries are documented in the literature in 23-42% of the cases. Special attention is paid to diabetes and its end-stage complications. Failure of wound healing, infection of the wound and lymphatic fistulas are the most common non-vascular complications. Inguinal incisions often give rise to a failure of wound healing caused by subcutaneous lymphatic vessels and because of the proximity to the anogenital region. Asepsis, atraumatic operative techniques and perioperative antimicrobial prophylaxis lead to a reduction of surgical site infections and healing delay. Failing grafts or infection of the bypass are the most common vascular complications. Early graft failures are often caused by inappropriate handling or operation techniques and long-term failure is often related to the bypass material. However, in peripheral vascular surgery, autologous veins are superior to synthetic grafts and provide advantages in cases of infection. Removal of an infected synthetic graft is discussed as well as in-situ or extra-anatomical reconstructions. This article reviews the postoperative complications of vascular surgery and their management.

Chylous complications of various severity and manifestations within diverse compartments in reconstructive vascular surgery #) #) The manuscript is dedicated to Prof. Dr. Z. Halloul

“…Postreconstructive lymphatic edema occurs in 70 to 100 % of cases, in 85 % of cases after femoro-popliteal and in 15 % after aorto-iliac bypass operations [5]. The occurrence of lymphatic fistulas in case of inguinal access site ranges from 0.8 to 18 % [6].…”

Vacuum-Assisted Closure versus Closure without Vacuum Assistance for Preventing Surgical Site Infections and Infections of Chronic Wounds: A Meta-Analysis of Randomized Controlled Trials

“…However, wound healing can occasionally be delayed by diabetes mellitus, impaired perfusion, or increased age, and can be complicated by local infections [5][6][7][8]. Animal studies have shown that VAC optimizes blood perfusion, decreases local edema by removing excess interstitial fluid, and reduces the bacterial load [9,10].…”

Frühergebnisse nach peripherem Gefäßersatz mit einer biosynthetischen Kollagenprothese bei Protheseninfektionen

“…Discussion: Treatment of vascular graft infections in peripheral bypass surgery in the absence of enFrühergebnisse nach peripherem Gefäßersatz mit einer biosynthetischen Kollagenprothese bei Protheseninfektionen Einleitung ! Die allgemeine Zunahme peripherer arteriosklerotischer Erkrankungen führt unmittelbar zu einer deutlichen Ausweitung gefäß-chirurgischer Rekonstruktionen mit alloplastischen Materialien [1]. Trotz gleichbleibender Rate an Infektionen von etwa 1 bis 6 % nimmt letztendlich die Gesamtzahl von Gefäßprothesen-infektionen deutlich zu [2].…”

“…Die Follow-up-Untersuchungen erfolgten in 7 von 8 Fällen in der leistungserbringenden Klinik, in einem Fall wurden externe Daten zur Auswertung genutzt. Die Kodierung und Gruppierung erfolgte mit der Software "ID Diacos ® 2011 Version: 6.91".Die epidemiologischen und klinischen Daten sind in l " Tab 1. dargestellt.…”

“…5 entnommen werden. Die absolute Zunahme der Protheseninfektionen bei steigenden Zahlen gefäßchirurgischer Rekonstruktionen mit Fremdmaterial stellt aufgrund der hohen Morbidität und Mortalität hohe Anforderungen an den Gefäßchirurgen[1,3,4]. Die grundsätzlichen Behandlungsschemata sind durch diverse Publikationen und letztendlich durch eine Leitlinie der Deutschen Gesellschaft für Gefäßchirurgie vorgegeben[2,11].…”