COMPLICATIONS OF VASCULAR-SURGERY

Vascular surgery, which in certain life-threatening situations is the only possible therapeutic option, has progressed considerably since it s beginning in the 1950s. Because of the constant progression of vascu lar diseases, this surgery will present, in the forthcoming years, a m ajor public health problem. Because of advances in medico-surgical man agement, evermore elderly and frail patients can be treated. Periopera tive mortality is constantly decreasing, but much progress remains to be accomplished to prevent, avoid or treat, postoperative complication s. They are common and serious in these typical patients with cardiova scular diseases (men over 50 years of age, heavy smokers, atheromatous ...). The AA divide these complications into 3 main groups depending o n the surgical procedure: abdominal aortic surgery, carotid surgery an d arterial and venous surgery of the lower limbs. There is much data o n abdominal aortic surgery because these long and complex procedures p roduce repercussions often involving many systems. The postoperative c omplications are treated according to the system they involve: cardiov ascular, the most serious, respiratory, the commonest, alimentary, neu rological, renal, others, as well as combined systems. The AA do not d eal with the specific problems associated with cardiac and cardio-thor acic surgery. The AA discuss the different epidemiological findings of the large surgical series published in the 1970s and 1980s. The more recent literature analyses the relationship between preoperative risk factors (atheroma, GOAD, hypertension...). peroperative problems (surg ical difficulties, emergencies, massive transfusions, others) and the corresponding postoperative morbidity. Thus a few general outlines of the physiopathology of these different complications emerge. In the li ght of these notions the few proposed methods will be evaluated in ord er to improve the preoperative condition of the vascular patient. The AA also review the relevance of the preoperative investigation in pati ents for vascular surgery. All these measures aim at reducing the inci dence and severity of perioperative morbidity.