Managing Complications of Vascular Surgery and Endovascular Therapy

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.KeywordsComplicationsBypassEndovascularInfrainguinalSurgeryManagement