Skip to main content

Management of Postoperative Complications

  • Chapter
  • 1925 Accesses

Abstract

Operative strategies for the treatment of descending thoracic and thoraco-abdominal aortic diseases have improved dramatically over the years, resulting in better surgical outcomes. Nevertheless, both open and endovascular procedures are at risk for morbidity and mortality. Major postoperative complications are pulmonary dysfunction, renal failure, cardiac events, re-exploration for bleeding, neurologic deficits, and gastrointestinal complications. A great deal of effort is usually applied in the preoperative and intraoperative periods by the entire management team, but successful outcomes depend on adequate monitoring, effective critical care, and appropriate multidisciplinary treatment of postoperative complications. In this chapter we focus on the management of neurologic, hemorrhagic/thrombotic, and gastrointestinal complications. Pulmonary, renal, and cardiac complications are addressed by other authors in this section.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   229.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Eagleton MJ, Greenberg RK. Late complications after endovascular thoracoabdominal aneurysm repair. Semin Vasc Surg 2009;22:87–92

    Article  PubMed  Google Scholar 

  2. Fischbein MP and Miller C. Long-term durability of open thoracic and thoracoabdominal aneurysm repair. Semin Vasc Surg 2009;22:74–80

    Article  PubMed  Google Scholar 

  3. McGarvey ML, Cheung AT, Szeto W et al. Management of neurologic complications of thoracic aortic surgery. J Clin Neurophysiol 2007;24:336–343

    PubMed  Google Scholar 

  4. Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg 2007;83:S862–S864

    Article  PubMed  Google Scholar 

  5. Chiesa R, Melissano G, Bertoglio L et al. The risk of spinal cord ischemia during thoracic aorta endo-grafting. Acta Chir Belg 2008;108:492–502

    PubMed  CAS  Google Scholar 

  6. Eberle B, Basciani R. Brain protection in thoracic aortic surgery — an interdisciplinary challenge. Appl Cardiopulm Pathophysiol 2009;13:160–164

    Google Scholar 

  7. Gandhy GY, Nuttal GA, Abel MD et al. Intensive intraoperative insuline therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med 2009;146:233–243

    Google Scholar 

  8. Higashida RT. Recent advances in the interventional treatment of acute ischemic stroke. Cerebrovasc Dis 2005;220(Suppl 2):S140–S147

    Article  Google Scholar 

  9. Sloan TB, Jameson LC. Electrophysiologic monitoring during surgery to repair the thoraco-abdominal aorta. J Clin Neurophysiol 2007;24:316–327

    PubMed  Google Scholar 

  10. Svensson LG, Nadolny EM, Penney DL et al. Prospective randomised neurocognitive and S-100 study of hypothermic circulatory arrest, retrograde brain perfusion, and antegrade brain perfusion for aortic arch operations. Ann Thorac Surg 2001;71:1905–1912

    Article  PubMed  CAS  Google Scholar 

  11. McGarvey ML, Mullen MT, Woo EY et al. The treatment of spinal cord ischemia following thoracic endovascular aortic repair. Neurocrit Care 2007;6:35–39

    Article  PubMed  Google Scholar 

  12. Estrera AL, Sheinbaum R, Miller CC et al. Cerebrospinal fluid drainage during thoracic aortic repair: safety and current management. Ann Thorac Surg 2009;88:9–15

    Article  PubMed  Google Scholar 

  13. Wynn MM, Mell MW, Tefera G et al. Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: a report of 486 patients treated from 1987 to 2008. J Vasc Surg 2009;49:29–35

    Article  PubMed  Google Scholar 

  14. Horlocker TT, Wedel DJ, Rowlingson JC et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010;35:64–101

    Article  PubMed  CAS  Google Scholar 

  15. Cinà CS and Clase CM. Coagulation disorders and blood product use in patients undergoing thoracoabdominal aortic aneurysm repair. Transfus Med Rev 2005;19:143–154

    Article  PubMed  Google Scholar 

  16. Monaco M, Di Tommaso L, Stassano P et al. Impact of blood coagulation and fibrinolytic system changes on early and mid term clinical outcome in patients undergoing stent endografting surgery. Interact Cardiovasc Thorac Surg 2006;5:724–729

    Article  PubMed  Google Scholar 

  17. Hardy JF, de Moerloose P, Samama M et al. Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Can J Anesth 2004;51:293–310

    Article  PubMed  Google Scholar 

  18. Levi M, Cromheecke M, Prins M et al. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet 1999;354:1940–1946

    Article  PubMed  CAS  Google Scholar 

  19. Crescenzi G, Landoni G, Biondi-Zoccai G et al. Desmopressin reduces transfusion needs after surgery: a meta-analysis of randomized clinical trials. Anesthesiology 2008;109:1063–1076

    Article  PubMed  CAS  Google Scholar 

  20. Zangrillo A, Mizzi A, Biondi-Zoccai G et al. Recombinant activated factor VII in cardiac surgery: a meta-analysis. J Cardiothorac Vasc Anesth 2009;23:34–40

    Article  PubMed  CAS  Google Scholar 

  21. Warren OJ, Alcock EMH, Choong AMTL et al. Recombinant Activated Factor VII: a solution to refractory haemorrhage in vascular surgery? Eur J Vasc Endovasc Surg 2008;35:145–152

    Article  PubMed  CAS  Google Scholar 

  22. Rahe-Meyer N, Solomon C, Winterhalter M et al. Thromboelastometry-guided administration of fibrinogen concentrate for the treatment of excessive intraoperative bleeding in thoracoabdominal aortic aneurysm surgery. J Thorac Cardiovasc Surg 2009;138:694–702

    Article  PubMed  Google Scholar 

  23. De Maistre E, Terriat B, Lesne-Padieu AS et al. High incidence of venous thrombosis after surgery for abdominal aortic aneurysm. J Vasc Surg 2009;49:596–601

    Article  PubMed  Google Scholar 

  24. Abboud B, Daher R, Boujaoude J. Acute mesenteric ischemia after cardio-pulmonary bypass surgery. World J Gastroenterol 2008;14:5361–5370

    Article  PubMed  Google Scholar 

  25. Hessel EA. Abdominal organ injury after cardiac surgery. Semin Cardiothorac Vasc Anesth 2004; 8:243–263

    Article  PubMed  Google Scholar 

  26. Back MR, Bandyk M, Bradner M et al. Critical analysis of outcome determinants affecting repair of intact aneurysms involving the visceral aorta. Ann Vasc Surg 2005;19:648–656

    Article  PubMed  Google Scholar 

  27. Durrani NK, Trisal V, Mittal V, Hans SS. Gastrointestinal complications after ruptured aortic aneurysm repair. Am Surg 2003;69:330–333

    PubMed  Google Scholar 

  28. Achouh PE, Madsen K, Miller CC et al. Gastrointestinal complications after descending thoracic and thoracoabdominal aortic repairs: a 14-year experience. J Vasc Surg 2006;44:442–446

    Article  PubMed  Google Scholar 

  29. Edwards E, Sidebotham D, Smith M et al. Diagnosis and outcome from suspected mesenteric ischaemia following cardiac surgery. Anaesth Intensive Care 2005;33:210–217

    PubMed  CAS  Google Scholar 

  30. Gosh S, Roberts N, Firmin RK et al. Risk factors for intestinal ischaemia in cardiac surgical patients. Eur J Cardiothorac Surg 2002;21:411–416

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Italia

About this chapter

Cite this chapter

Covello, R.D., Zangrillo, A. (2011). Management of Postoperative Complications. In: Chiesa, R., Melissano, G., Zangrillo, A. (eds) Thoraco-Abdominal Aorta. Springer, Milano. https://doi.org/10.1007/978-88-470-1857-0_25

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-1857-0_25

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1856-3

  • Online ISBN: 978-88-470-1857-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics