Postoperative Care Following Major Vascular Surgery

  • Giuseppe Papia
  • Thomas F. Lindsay


Routine postoperative management following major vascular surgery has evolved significantly. Surgical techniques are moving toward minimizing the invasiveness of procedures such as endovascular repair of complicated aortic aneurysms and the use of local and/or regional blocks when performing operations.


Chronic Obstructive Pulmonary Disease Abdominal Aorta Aneurysm Statin Therapy Abdominal Compartment Syndrome Bowel Ischemia 
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  1. 1.
    Hadjianastassiou VG, Tekkis PP, Goldhill DR, et al. Quantification of mortality risk after abdominal aortic aneurysm repair. Br J Surg. 2005;92(9):1092–1098.PubMedCrossRefGoogle Scholar
  2. 2.
    Boersma E, Poldermans D, Bax JJ, et al. Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA. 2001;285(14):1865–1873.PubMedCrossRefGoogle Scholar
  3. 3.
    Bastounis E, Filis K, Georgopoulos S, et al. Selective use of the intensive care unit after elective infrarenal abdominal aortic aneurysm repair. Int Angiol. 2003;22(3):308–316.PubMedGoogle Scholar
  4. 4.
    Sprung J, Abdelmalak B, Gottlieb A, et al. Analysis of risk factors for myocardial infarction and cardiac mortality after major vascular surgery. Anesthesiology. 2000;93(1):129–140.PubMedCrossRefGoogle Scholar
  5. 5.
    Hassen TA, Pearson S, Cowled PA, et al. Preoperative nutritional status predicts the severity of the systemic inflammatory response syndrome (SIRS) following major vascular surgery. Eur J Vasc Endovasc Surg. 2007;33(6):696–702.PubMedCrossRefGoogle Scholar
  6. 6.
    Lawlor DK, Lovell MB, DeRose G, et al. Is intensive care necessary after elective abdominal aortic aneurysm repair? Can J Surg. 2004;47(5):359–363.PubMedGoogle Scholar
  7. 7.
    Sandham JD, Hull RD, Brant RF, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003;348(1):5–14.PubMedCrossRefGoogle Scholar
  8. 8.
    Gopalan PD, Burrows RC. Critical care of the vascular surgery patient. Crit Care Clin. 2003;19(1):109–125.PubMedCrossRefGoogle Scholar
  9. 9.
    Papia G, Klein D, Lindsay TF. Intensive care of the patient following open abdominal aortic surgery. Curr Opin Crit Care. 2006;12(4):340–345.PubMedCrossRefGoogle Scholar
  10. 10.
    Krul JM, van Gijn J, Ackerstaff RG, et al. Site and pathogenesis of infarcts associated with carotid endarterectomy. Stroke. 1989;20(3):324–328.PubMedCrossRefGoogle Scholar
  11. 11.
    McArdle PJ, Sanders KD. Postoperative care of vascular surgery patients. Anesthesiol Clin North America. 2004;22(2):333–347.PubMedCrossRefGoogle Scholar
  12. 12.
    Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care: transfusion requirements in critical care investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340(6):409–417.PubMedCrossRefGoogle Scholar
  13. 13.
    Hebert PC, Yetisir E, Martin C, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med. 2001;29(2):227–234.PubMedCrossRefGoogle Scholar
  14. 14.
    Mangano DT. Perioperative cardiac morbidity. Anesthesiology. 1990;72(1):153–184.PubMedCrossRefGoogle Scholar
  15. 15.
    Le Manach Y, Perel A, Coriat P, et al. Early and delayed myocardial infarction after abdominal aortic surgery. Anesthesiology. 2005;102(5):885–891.PubMedCrossRefGoogle Scholar
  16. 16.
    Frank SM, Beattie C, Christopherson R, et al. Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. ­Anesthesiology. 1992;77(2):252–257.PubMedCrossRefGoogle Scholar
  17. 17.
    Stevens RD, Burri H, Tramer MR. Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Anesth Analg. 2003;97(3):623–633.PubMedCrossRefGoogle Scholar
  18. 18.
    Lindenauer PK, Pekow P, Wang K, et al. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med. 2005;353(4):349–361.PubMedCrossRefGoogle Scholar
  19. 19.
    Shammash JB, Trost JC, Gold JM, et al. Perioperative beta-blocker withdrawal and mortality in vascular surgical patients. Am Heart J. 2001;141(1):148–153.PubMedCrossRefGoogle Scholar
  20. 20.
    O’Neil-Callahan K, Katsimaglis G, Tepper MR, et al. Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study. J Am Coll Cardiol. 2005;45(3):336–342.PubMedCrossRefGoogle Scholar
  21. 21.
    Crisby M, Nordin-Fredriksson G, Shah PK, et al. Pravastatin treatment increases collagen content and decreases lipid content, inflammation, metalloproteinases, and cell death in human carotid plaques: implications for plaque stabilization. Circulation. 2001;103(7):926–933.PubMedCrossRefGoogle Scholar
  22. 22.
    Le Manach Y, Godet G, Coriat P, et al. The impact of postoperative discontinuation or continuation of chronic statin therapy on cardiac outcome after major vascular surgery. Anesth Analg. 2007;104(6):1326–1333.PubMedCrossRefGoogle Scholar
  23. 23.
    Schouten O, Hoeks SE, Welten GM, et al. Effect of statin withdrawal on frequency of cardiac events after vascular surgery. Am J Cardiol. 2007;100(2):316–320.PubMedCrossRefGoogle Scholar
  24. 24.
    Durazzo AE, Machado FS, Ikeoka DT, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg. 2004;39(5):967–975.PubMedCrossRefGoogle Scholar
  25. 25.
    Kertai MD, Boersma E, Westerhout CM, et al. A combination of statins and beta-blockers is independently associated with a reduction in the incidence of perioperative mortality and nonfatal myocardial infarction in patients undergoing abdominal aortic aneurysm surgery. Eur J Vasc Endovasc Surg. 2004;28(4): 343–352.PubMedCrossRefGoogle Scholar
  26. 26.
    Friedrich JO, Adhikari N, Herridge MS, et al. Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med. 2005;142(7):510–524.PubMedCrossRefGoogle Scholar
  27. 27.
    Halpenny M, Rushe C, Breen P, et al. The effects of fenoldopam on renal function in patients undergoing elective aortic surgery. Eur J Anaesthesiol. 2002;19(1):32–39.PubMedGoogle Scholar
  28. 28.
    Miller Q, Peyton BD, Cohn EJ, et al. The effects of intraoperative fenoldopam on renal blood flow and tubular function following suprarenal aortic cross-clamping. Ann Vasc Surg. 2003;17(6):656–662.PubMedCrossRefGoogle Scholar
  29. 29.
    Brezis M, Rosen S, Silva P, et al. Transport activity modifies thick ascending limb damage in the isolated perfused kidney. Kidney Int. 1984;25(1):65–72.PubMedCrossRefGoogle Scholar
  30. 30.
    Rahman SN, Kim GE, Mathew AS, et al. Effects of atrial natriuretic peptide in clinical acute renal failure. Kidney Int. 1994;45(6):1731–1738.PubMedCrossRefGoogle Scholar
  31. 31.
    Macedo E, Abdulkader R, Castro I, et al. Lack of protection of N-acetylcysteine (NAC) in acute renal failure related to elective aortic aneurysm repair: a randomized controlled trial. Nephrol Dial Transplant. 2006;21(7):1863–1869.PubMedCrossRefGoogle Scholar
  32. 32.
    Johnson RG, Arozullah AM, Neumayer L, et al. Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg. 2007;204(6):1188–1198.PubMedCrossRefGoogle Scholar
  33. 33.
    Khuri SF, Daley J, Henderson W, et al. The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg. 1995;180(5):519–531.PubMedGoogle Scholar
  34. 34.
    Khuri SF, Henderson WG, DePalma RG, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242(3):326–341.PubMedGoogle Scholar
  35. 35.
    Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8):596–608.PubMedCrossRefGoogle Scholar
  36. 36.
    Lindsay TF, Luo XP, Lehotay DC, et al. Ruptured abdominal aortic aneurysm, a “two-hit” ischemia/reperfusion injury: evidence from an analysis of oxidative products. J Vasc Surg. 1999;30(2):219–228.PubMedCrossRefGoogle Scholar
  37. 37.
    Cambria RP, Clouse WD, Davison JK, et al. Thoracoabdominal aneurysm repair: results with 337 operations performed over a 15-year interval. Ann Surg. 2002;236(4):471–479.PubMedCrossRefGoogle Scholar
  38. 38.
    Diedrich DA, Keegan MT, Brown DR. Tracheostomy after major vascular surgery. J Cardiothorac Vasc Anesth. 2006;20(1):14–19.PubMedCrossRefGoogle Scholar
  39. 39.
    Champagne BJ, Darling RC, Daneshmand M, et al. Outcome of aggressive surveillance colonoscopy in ruptured abdominal aortic aneurysm. J Vasc Surg. 2004;39(4):792–796.PubMedCrossRefGoogle Scholar
  40. 40.
    Bjorck M, Lindberg F, Broman G, et al. pHi monitoring of the sigmoid colon after aortoiliac surgery: a five-year prospective study. Eur J Vasc Endovasc Surg. 2000;20(3):273–280.PubMedCrossRefGoogle Scholar
  41. 41.
    Kehlet H, Moesgaard F. Prophylaxis against postoperative complications in gastroenterology. Scand J Gastroenterol Suppl. 1996;216:218–224.PubMedCrossRefGoogle Scholar
  42. 42.
    Ivatury RR, Diebel L, Porter JM, et al. Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am. 1997;77(4):783–800.PubMedCrossRefGoogle Scholar
  43. 43.
    Mangano DT, Siliciano D, Hollenberg M, et al. Postoperative myocardial ischemia: therapeutic trials using intensive analgesia following surgery – The Study of Perioperative Ischemia (SPI) Research Group. Anesthesiology. 1992;76(3):342–353.PubMedCrossRefGoogle Scholar
  44. 44.
    Kock M, Blomberg S, Emanuelsson H, et al. Thoracic epidural anesthesia improves global and regional left ventricular function during stress-induced myocardial ischemia in patients with coronary artery disease. Anesth Analg. 1990;71(6):625–630.PubMedCrossRefGoogle Scholar
  45. 45.
    Maziak DE, Lindsay TF, Marshall JC, et al. The impact of multiple organ dysfunction on mortality following ruptured abdominal aortic aneurysm repair. Ann Vasc Surg. 1998;12(2):93–100.PubMedCrossRefGoogle Scholar
  46. 46.
    Rothwell PM, Eliasziw M, Gutnikov SA, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003;361(9352):107–116.PubMedCrossRefGoogle Scholar
  47. 47.
    Brooke BS, McGirt MJ, Woodworth GF, et al. Preoperative statin and diuretic use influence the presentation of patients undergoing carotid endarterectomy: results of a large single-institution case-control study. J Vasc Surg. 2007;45(2):298–303.PubMedCrossRefGoogle Scholar
  48. 48.
    McGirt MJ, Perler BA, Brooke BS, et al. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce the risk of perioperative stroke and mortality after carotid endarterectomy. J Vasc Surg. 2005;42(5):829–836.PubMedCrossRefGoogle Scholar
  49. 49.
    Sheehan MK, Baker WH, Littooy FN, et al. Timing of postcarotid complications: a guide to safe discharge planning. J Vasc Surg. 2001;34(1):13–16.PubMedCrossRefGoogle Scholar
  50. 50.
    Motamed C, Motamed-Kazerounian G, Merle JC, et al. Cardiac troponin I assessment and late cardiac complications after carotid stenting or endarterectomy. J Vasc Surg. 2005;41(5):769–774.PubMedCrossRefGoogle Scholar
  51. 51.
    Howell SJ. Carotid endarterectomy. Br J Anaesth. 2007;99(1): 119–131.PubMedCrossRefGoogle Scholar
  52. 52.
    Scozzafava J, Hussain MS, Yeo T, et al. Case report: aggressive blood pressure management for carotid endarterectomy hyperperfusion syndrome. Can J Anaesth. 2006;53(8):764–768.PubMedCrossRefGoogle Scholar
  53. 53.
    Ballotta E, Dagiau G, Saladini M, et al. Results of electroencephalographic monitoring during 369 consecutive carotid artery revascularizations. Eur Neurol. 1997;37(1):43–47.PubMedCrossRefGoogle Scholar
  54. 54.
    Vemuri C, Wainess RM, Dimick JB, et al. Effect of increasing patient age on complication rates following intact abdominal aortic aneurysm repair in the United States. J Surg Res. 2004;118(1): 26–31.PubMedCrossRefGoogle Scholar
  55. 55.
    Gelman S. The pathophysiology of aortic cross-clamping and unclamping. Anesthesiology. 1995;82(4):1026–1060.PubMedCrossRefGoogle Scholar
  56. 56.
    Alpert RA, Roizen MF, Hamilton WK, et al. Intraoperative urinary output does not predict postoperative renal function in patients undergoing abdominal aortic revascularization. Surgery. 1984;95(6):707–711.PubMedGoogle Scholar
  57. 57.
    Avrahami R, Cohen JD, Haddad M, et al. Gastric emptying after elective abdominal aortic aneurysm surgery: the case for early postoperative enteral feeding. Eur J Vasc Endovasc Surg. 1999;17(3):241–244.PubMedCrossRefGoogle Scholar
  58. 58.
    Fraser RJ, Ritz M, Di Matteo AC, et al. Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery. World J Gastroenterol. 2006;12(4):582–587.PubMedGoogle Scholar
  59. 59.
    Gillum RF. Epidemiology of aortic aneurysm in the United States. J Clin Epidemiol. 1995;48(11):1289–1298.PubMedCrossRefGoogle Scholar
  60. 60.
    Woody JD, Makaroun MS. Endovascular graft limb occlusion. Semin Vasc Surg. 2004;17(4):262–267.PubMedCrossRefGoogle Scholar
  61. 61.
    Blankensteijn JD, de Jong SE, Prinssen M, et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2005;352(23):2398–2405.PubMedCrossRefGoogle Scholar
  62. 62.
    Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351(16):1607–1618.PubMedCrossRefGoogle Scholar
  63. 63.
    Bertrand M, Godet G, Koskas F, et al. Endovascular treatment of abdominal aortic aneurysms: is there a benefit regarding postoperative outcome? Eur J Anaesthesiol. 2001;18(4):245–250.PubMedGoogle Scholar
  64. 64.
    Sweeney KJ, Evoy D, Sultan S, et al. Endovascular approach to abdominal aortic aneurysms limits the postoperative systemic immune response. Eur J Vasc Endovasc Surg. 2002;23(4): 303–308.PubMedCrossRefGoogle Scholar
  65. 65.
    Alsac JM, Desgranges P, Kobeiter H, et al. Emergency endovascular repair for ruptured abdominal aortic aneurysms: feasibility and comparison of early results with conventional open repair. Eur J Vasc Endovasc Surg. 2005;30(6):632–639.PubMedCrossRefGoogle Scholar
  66. 66.
    Larzon T, Lindgren R, Norgren L. Endovascular treatment of ruptured abdominal aortic aneurysms: a shift of the paradigm? J Endovasc Ther. 2005;12(5):548–555.PubMedCrossRefGoogle Scholar
  67. 67.
    Etz CD, Di Luozzo G, Bello R, et al. Pulmonary complications after descending thoracic and thoracoabdominal aortic aneurysm repair: predictors, prevention, and treatment. Ann Thorac Surg. 2007;83(2):S870–S876.PubMedCrossRefGoogle Scholar
  68. 68.
    Huynh TT, Miller CC, Estrera AL, et al. Thoracoabdominal and descending thoracic aortic aneurysm surgery in patients aged 79 years or older. J Vasc Surg. 2002;36(3):469–475.PubMedCrossRefGoogle Scholar
  69. 69.
    Schepens MA, Kelder JC, Morshuis WJ, et al. Long-term follow-up after thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2007;83(2):S851–S855.PubMedCrossRefGoogle Scholar
  70. 70.
    Svensson LG, Hess KR, Coselli JS, et al. A prospective study of respiratory failure after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg. 1991;14(3):271–282.PubMedCrossRefGoogle Scholar
  71. 71.
    Dagher NN, Modrall JG. Pharmacotherapy before and after revascularization: anticoagulation, antiplatelet agents, and statins. Semin Vasc Surg. 2007;20(1):10–14.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Giuseppe Papia
    • 1
  • Thomas F. Lindsay
    • 2
  1. 1.Division of Cardiac and Vascular Surgery, Department of Critical Care Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
  2. 2.Department of Surgery,Toronto General HospitalUniversity of TorontoTorontoCanada

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