Abstract
The literature describing the merits of open and endovascular arterial therapy for lower extremity peripheral arterial occlusive disease is well represented with details of technique and operative results. Despite the robust data describing the efficacy and impact of infrainguinal arterial reconstruction on quality of life and limb salvage, little focus is placed on the potential complications that can befall patients who undergo these interventions. Frequently, revascularization strategies require complex considerations regarding a variety of variables, including the inflow vessel, distal target, hemodynamic impact of the involved lesion(s), conduit availability and quality, and perhaps most importantly, anticipated benefit to the patient. Even in the most optimal situation, the most experienced and competent vascular specialist will encounter a myriad of complications in the management of peripheral vascular arterial occlusive disease. These problems reflect the complexity of the anatomic and patient-specific covariates that invariably impact outcome. Over the last two decades, the contemporary vascular surgeon has seen a paradigm shift in the management of lower extremity occlusive disease due to the rapid proliferation and adoption of innumerable endoluminal therapies. With this change, more and more patients are undergoing revascularization because previous so-called “high-risk” or “no-option” patients receive hybrid or endoluminal salvage procedures. The impact of these new treatment strategies is under increasing scrutiny, and calls for comparative effectiveness research have been clearly vocalized. A number of previously unforeseen or unanticipated complications have been introduced into the care of these patients as a result of these novel techniques. Complications that result from the management of peripheral arterial disease frequently result in amputation or death. Accordingly, the contemporary vascular surgeon needs to be well versed in the management of complications that may occur with both open and endovascular treatment of peripheral vascular disease. This chapter highlights the technical complications and subsequent management strategies of infrainguinal bypass surgery, as well as, those resulting from endovascular treatment of lower extremity ischemia.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bergamini TM, et al. Experience with in situ saphenous vein bypasses during 1981 to 1989: determinant factors of long-term patency. J Vasc Surg. 1991;13(1):137–47. Discussion 148–9.
Sladen JG, Gilmour JL. Vein graft stenosis. Characteristics and effect of treatment. Am J Surg. 1981;141(5):549–53.
Berceli SA, et al. Surgical and endovascular revision of infrainguinal vein bypass grafts: analysis of midterm outcomes from the PREVENT III trial. J Vasc Surg. 2007;46(6):1173–9.
Bandyk DF, et al. Durability of the in situ saphenous vein arterial bypass: a comparison of primary and secondary patency. J Vasc Surg. 1987;5(2):256–68.
Cohen JR, et al. Recognition and management of impending vein-graft failure. Importance for long-term patency. Arch Surg. 1986;121(7):758–9.
Bandyk DF, et al. Durability of vein graft revision: the outcome of secondary procedures. J Vasc Surg. 1991;13(2):200–8. Discussion 209–10.
Rzucidlo EM, et al. Prediction of early graft failure with intraoperative completion duplex ultrasound scan. J Vasc Surg. 2002;36(5):975–81.
Bandyk DF, et al. Monitoring functional patency of in situ saphenous vein bypasses: the impact of a surveillance protocol and elective revision. J Vasc Surg. 1989;9(2):286–96.
Seeger JM, et al. Potential predictors of outcome in patients with tissue loss who undergo infrainguinal vein bypass grafting. J Vasc Surg. 1999;30(3):427–35.
Stept LL, et al. Technical defects as a cause of early graft failure after femorodistal bypass. Arch Surg. 1987;122(5):599–604.
Donaldson MC, Mannick JA, Whittemore AD. Causes of primary graft failure after in situ saphenous vein bypass grafting. J Vasc Surg. 1992;15(1):113–8. Discussion 118–20.
Raffetto JD, et al. Differences in risk factors for lower extremity arterial occlusive disease. J Am Coll Surg. 2005;201(6):918–24.
Gibson KD, et al. Identification of factors predictive of lower extremity vein graft thrombosis. J Vasc Surg. 2001;33(1):24–31.
Woodburn KR, et al. Clinical, biochemical, and rheologic factors affecting the outcome of infrainguinal bypass grafting. J Vasc Surg. 1996;24(4):639–46.
Saltzberg SS, et al. Outcome of lower-extremity revascularization in patients younger than 40 years in a predominantly diabetic population. J Vasc Surg. 2003;38(5):1056–9.
Taylor Jr LM, Edwards JM, Porter JM. Present status of reversed vein bypass grafting: five-year results of a modern series. J Vasc Surg. 1990;11(2):193–205. Discussion 205–6.
Neville RF, Tempesta B, Sidway AN. Tibial bypass for limb salvage using polytetrafluoroethylene and a distal vein patch. J Vasc Surg. 2001;33(2):266–71. Discussion 271–2.
Neville RF, et al. Distal vein patch with an arteriovenous fistula: a viable option for the patient without autogenous conduit and severe distal occlusive disease. J Vasc Surg. 2009;50(1):83–8.
Moawad J, Gagne P. Adjuncts to improve patency of infrainguinal prosthetic bypass grafts. Vasc Endovascular Surg. 2003;37(6):381–6.
Erickson CA, et al. Ongoing vascular laboratory surveillance is essential to maximize long-term in situ saphenous vein bypass patency. J Vasc Surg. 1996;23(1):18–26. Discussion 26–7.
Rhodes JM, et al. The benefits of secondary interventions in patients with failing or failed pedal bypass grafts. Am J Surg. 1999;178(2):151–5.
Nguyen LL, et al. Infrainguinal vein bypass graft revision: factors affecting long-term outcome. J Vasc Surg. 2004;40(5):916–23.
Landry GJ, et al. Long-term outcome of revised lower-extremity bypass grafts. J Vasc Surg. 2002;35(1):56–62. Discussion 62–3.
Pomposelli FB, et al. A decade of experience with dorsalis pedis artery bypass: analysis of outcome in more than 1000 cases. J Vasc Surg. 2003;37(2):307–15.
Sullivan Jr TR, et al. Clinical results of common strategies used to revise infrainguinal vein grafts. J Vasc Surg. 1996;24(6):909–17. Discussion 917–9.
Schneider PA, Caps MT, Nelken N. Infrainguinal vein graft stenosis: cutting balloon angioplasty as the first-line treatment of choice. J Vasc Surg. 2008;47(5):960–6. Discussion 966.
Alpert JR, et al. Treatment of vein graft stenosis by balloon catheter dilation. JAMA. 1979;242(25):2769–71.
Simosa HF, et al. Predictors of failure after angioplasty of infrainguinal vein bypass grafts. J Vasc Surg. 2009;49(1):117–21.
Whittemore AD, et al. Secondary femoropopliteal reconstruction. Ann Surg. 1981;193(1):35–42.
Belkin M, et al. Observations on the use of thrombolytic agents for thrombotic occlusion of infrainguinal vein grafts. J Vasc Surg. 1990;11(2):289–94. Discussion 295–6.
Nackman GB, et al. Thrombolysis of occluded infrainguinal vein grafts: predictors of outcome. J Vasc Surg. 1997;25(6):1023–31. Discussion 1031–2.
Belkin M. Secondary bypass after infrainguinal bypass graft failure. Semin Vasc Surg. 2009;22(4):234–9.
Andros G, et al. Arm veins for arterial revascularization of the leg: arteriographic and clinical observations. J Vasc Surg. 1986;4(5):416–27.
Harward TR, et al. The use of arm vein conduits during infrageniculate arterial bypass. J Vasc Surg. 1992;16(3):420–6. Discussion 426–7.
Greenblatt DY, Rajamanickam V, Mell MW. Predictors of surgical site infection after open lower extremity revascularization. J Vasc Surg. 2011;54(2):433–9.
Giles KA, et al. Body mass index: surgical site infections and mortality after lower extremity bypass from the National Surgical Quality Improvement Program 2005-2007. Ann Vasc Surg. 2010;24(1):48–56.
Childress BB, et al. Impact of an absorbent silver-eluting dressing system on lower extremity revascularization wound complications. Ann Vasc Surg. 2007;21(5):598–602.
Alkon JD, et al. Management of complex groin wounds: preferred use of the rectus femoris muscle flap. Plast Reconstr Surg. 2005;115(3):776–83. Discussion 784–5.
Veith FJ. Presidential address: Charles Darwin and vascular surgery. J Vasc Surg. 1997;25(1):8–18.
Messina LM, et al. Clinical characteristics and surgical management of vascular complications in patients undergoing cardiac catheterization: interventional versus diagnostic procedures. J Vasc Surg. 1991;13(5):593–600.
Nowygrod R, et al. Trends, complications, and mortality in peripheral vascular surgery. J Vasc Surg. 2006;43(2):205–16.
Hoffer EK, Bloch RD. Percutaneous arterial closure devices. J Vasc Interv Radiol. 2003;14(7):865–85.
Singh H, et al. Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 2003;14(9 Pt 2):S283–8.
Fitts J, et al. Fluoroscopy-guided femoral artery puncture reduces the risk of PCI-related vascular complications. J Interv Cardiol. 2008;21(3):273–8.
Oweida SW, et al. Postcatheterization vascular complications associated with percutaneous transluminal coronary angioplasty. J Vasc Surg. 1990;12(3):310–5.
McCann RL, Schwartz LB, Pieper KS. Vascular complications of cardiac catheterization. J Vasc Surg. 1991;14(3):375–81.
Starnes BW, et al. Percutaneous arterial closure in peripheral vascular disease: a prospective randomized evaluation of the Perclose device. J Vasc Surg. 2003;38(2):263–71.
Mackrell PJ, et al. Can the Perclose suture-mediated closure system be used safely in patients undergoing diagnostic and therapeutic angiography to treat chronic lower extremity ischemia? J Vasc Surg. 2003;38(6):1305–8.
Wilson JS, et al. Management of vascular complications following femoral artery catheterization with and without percutaneous arterial closure devices. Ann Vasc Surg. 2002;16(5):597–600.
Koreny M, et al. Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis. JAMA. 2004;291(3):350–7.
Goodney PP, Chang RW, Cronenwett JL. A percutaneous arterial closure protocol can decrease complications after endovascular interventions in vascular surgery patients. J Vasc Surg. 2008;48(6):1481–8.
Muller-Hulsbeck S, et al. Final results of the protected superficial femoral artery trial using the FilterWire EZ system. Cardiovasc Intervent Radiol. 2010;33(6):1120–7.
Shrikhande GV, et al. Lesion types and device characteristics that predict distal embolization during percutaneous lower extremity interventions. J Vasc Surg. 2011;53(2):347–52.
Scali ST, et al. Long-term results of open and endovascular revascularization of superficial femoral artery occlusive disease. J Vasc Surg. 2011;54(3):714–21.
Gallagher KA, et al. Endovascular management as first therapy for chronic total occlusion of the lower extremity arteries: comparison of balloon angioplasty, stenting, and directional atherectomy. J Endovasc Ther. 2011;18(5):624–37.
Iida O, et al. Long-term outcomes and risk stratification of patency following nitinol stenting in the femoropopliteal segment: retrospective multicenter analysis. J Endovasc Ther. 2011;18(6):753–61.
Taylor SM, et al. Clinical success using patient-oriented outcome measures after lower extremity bypass and endovascular intervention for ischemic tissue loss. J Vasc Surg. 2009;50(3):534–41. Discussion 541.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media New York
About this chapter
Cite this chapter
Scali, S.T., Flynn, T.C. (2012). Managing Complications of Vascular Surgery and Endovascular Therapy. In: Shrikhande, G., McKinsey, J. (eds) Diabetes and Peripheral Vascular Disease. Contemporary Diabetes. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-158-5_11
Download citation
DOI: https://doi.org/10.1007/978-1-62703-158-5_11
Published:
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-62703-157-8
Online ISBN: 978-1-62703-158-5
eBook Packages: MedicineMedicine (R0)