Postoperative Komplikationen in der Gefässchirurgie

TY - JOUR

T1 - Postoperative Komplikationen in der Gefässchirurgie

AU - Diener, H

AU - Larena-Avellaneda, A

AU - Debus, E S

PY - 2009/9

Y1 - 2009/9

N2 - 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.

AB - 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.

KW - Arterial Occlusive Diseases/surgery

KW - Comorbidity

KW - Diabetes Complications/diagnosis

KW - Humans

KW - Postoperative Complications/diagnosis

KW - Prosthesis-Related Infections/diagnosis

KW - Reoperation

KW - Risk Factors

KW - Vascular Surgical Procedures

U2 - 10.1007/s00104-009-1692-1

DO - 10.1007/s00104-009-1692-1

M3 - SCORING: Review

C2 - 19693475

VL - 80

SP - 814

EP - 826

JO - CHIRURG

JF - CHIRURG

SN - 0009-4722

IS - 9

ER -