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Infrainguinal open reconstruction: a review of surgical considerations and expected outcomes

Authors Komshian SR, Lu K, Pike SL, Siracuse JJ

Received 30 January 2017

Accepted for publication 27 March 2017

Published 8 May 2017 Volume 2017:13 Pages 161—168


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Daniel Duprez

Sevan R Komshian, Kimberly Lu, Steven L Pike, Jeffrey J Siracuse

Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA, USA

Abstract: Infrainguinal arterial occlusive disease can lead to potentially disabling and limb-threatening conditions. Revascularization may be indicated for claudication, rest pain, or tissue loss. Although endovascular interventions are becoming more prevalent, open surgeries such as endarterectomy and bypass are still needed and performed regularly. Open reconstruction has been associated with postoperative morbidity, both at the local and at the systemic levels. Local complications include surgical site infections (SSIs 0–5.3%), graft failure (12–60%), and amputation (5.7–27%), and more systemic issues include cardiac (2.6–18.4%), respiratory (2.5%), renal (4%), neurovascular (1.5%), and thromboembolic (0.2–1%) complications. While such outcomes present an additional challenge to the postoperative management of surgical patients, it may be possible to minimize their occurrence through careful risk stratification and preoperative assessment. Therefore, individualized selection of candidates for open repair requires weighing the need for intervention against the likelihood of adverse outcomes based on preoperative risk factors. This review provides an overview of open reconstruction, focusing on identifying the clinical indications for surgery and perioperative morbidity and mortality.

Keywords: infrainguinal bypass, outcomes, risk factors

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