Risk factors for ischemic complications in vascular reconstructive surgeries

Abstract

Objective: There have been reports on postoperative ischemic complications with vascular reconstructive surgery. However, various factors, such as lesions, operative technique, and perioperative treatment, prevent analyzing the causes of ischemic complications in vascular reconstruction surgeries. In the present study, we analyzed the cause of ischemic complications for vascular reconstruction surgeries with the same operator, surgical procedure, and perioperative treatment and without focusing on the lesions.

Patients and methods: We retrospectively reviewed 66 patients, including 24 aneurysm cases and 42 ischemic disease cases, between 2008 and 2018. The patient group comprised 35 males and 31 females, and the patient mean age was 63.3 (23-87) years. We investigated the postoperative presence of symptomatic and asymptomatic cerebral ischemia on MRIDWI performed within 4 postoperative days. We conducted a statistical analysis of the ischemic complications and clinical and treatment factors.

Results: Symptomatic cerebral ischemia was detected in 3 cases, whereas asymptomatic ischemic findings were identified in 8 cases. All cases of symptomatic cerebral ischemia involved cerebral aneurysms. Results of a univariate analysis revealed an association between symptomatic cerebral ischemia and preoperative antithrombotic therapy (OR, 0.07; p = 0.049 (95 %CI; 0.007-0.8794)), clipping (OR, 4.8; p = 0.0501 (95 %CI; 1.641-342.9)), and aneurysm (OR, 14.16; p = 0.0423 (95 %CI; 0.6991-286.9)). Significant associations were found between asymptomatic cerebral ischemia and preoperative antithrombotic therapy [OR, 0.2941; p = 0.0514 (95 %CI; 0.08335-1.038)], aneurysms [OR, 7.8; p = 0.0146 (95 %CI; 1.414-43.04)] and radial artery grafts (RAGs) [OR, 6.8; p = 0.0192 (95 %CI; 1.410-32.98)]. Multivariate analysis identified clipping [OR, 5.462; p = 0.045 (95 %CI; 1.01-78.25] and preoperative antithrombotic therapy [OR, 0.187; p = 0.037 (95 %CI; 0.004-0.813)] as the risk factors for symptomatic cerebral ischemia. Further, a correlation was found between asymptomatic cerebral ischemia and RAGs [OR, 9.244; p = 0.00013 (95 %CI; 2.34-29.44)].

Conclusion: Ischemic complications associated with combined vascular reconstruction surgeries for cerebral aneurysms are possibly associated with procedures related to aneurysmal occlusions. Thus, vascular reconstruction surgeries can be performed relatively safely. Further, preoperative antithrombotic treatment should be considered, and caution is required for asymptomatic cerebral ischemia in RAG cases.

Keywords: Aneurysmal; Bypass; Ischemic; Radial artery graft.