Perioperative complications following major vascular surgery.  Correlations with preoperative clinical, electrocardiographic and echocardiographic features

Dimitri Tsialtas; Maria Giulia Bolognesi; Stephania Assimopoulos; Matteo Azzarone; Riccardo Volpi; Roberto Bolognesi

doi:10.23750/abm.v93i3.12961

Perioperative complications following major vascular surgery. Correlations with preoperative clinical, electrocardiographic and echocardiographic features

Authors

Dimitri Tsialtas
Maria Giulia Bolognesi
Stephania Assimopoulos
Matteo Azzarone
Riccardo Volpi
Roberto Bolognesi a:1:{s:5:"en_US";s:32:"Università degli studi di Parma";}

Keywords:

vascular surgery, complications, risk factors, electrocardiography, echocardiography

Abstract

Background and aim: We investigated the incidence rate of perioperative complications following major vascular surgery, as well as identified the risk factors and preoperative clinical, electrocardiographic and echocardiographic determinants, related to these complications.

Methods: We studied 241 patients with asymptomatic intact abdominal aortic aneurysm (AAA) subjected to open surgical repair, 182 with critical carotid stenosis subjected to endarterectomy (CEA), and 158 with severe symptomatic occlusive peripheral artery disease subjected to aortofemoral bypass (AFB). Preoperatively, all subjects provided a medical history and underwent physical, laboratory examinations, a standard ECG, and transthoracic echocardiography.

Results: Overall, the perioperative mortality rate was 1.2%. The highest rate of complications was observed in the AAA group (p<0.01). Cardiac, respiratory, renal, gastrointestinal, and vascular complications were critically higher in the AAAs. Neurological complications were more common in the CEA compared to AAAs (p<0.01). Diabetic decompensation was more frequent in the AFB compared to the others (p<0.05). Mortality was correlated with left atrial enlargement and uricemia (p<0.03 respectively). Cardiac complications were correlated with heart rate (p<0.04), QT interval (p<0.001) and left ventricular mass (p<0.03), pulmonary with high levels of glycaemia (p<0.05) and overt diabetes (p<0.04), while renal insufficiency with hypertension (p<0.03), diabetes (p<0.01), previous myocardial infarction (p<0.01) and left anterior hemiblock (p<0.01), and neurological with hypertension (p<0.04) and overweight (p<0.01).

Conclusions: We report a high rate of perioperative complications in vascular patients undergoing surgical revascularization. Cardiac, respiratory, renal, hematological, and gastrointestinal complications were predominant in the AAA group. Mortality appears significantly related to left atrial dimension and uricemia.

References

Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 2014;35:2383-2431.

Devereaux PJ, Sessler DI. Cardiac Complications in Patients Undergoing Major Noncardiac Surgery. N Engl J Med 2015;373:2258-2269.

Tsialtas D, Bolognesi MG, Tecchio T, Azzarone M, Quaini F, Bolognesi R. Clinical, electrocardiographic and echocardiographic features in patients with major arterial vascular disease assigned to surgical revascularization. Vasa 2014;43:443-449.

Tsialtas D, Bolognesi MG, Volpi R, Bolognesi R. Atherosclerotic vascular diseases have really the same risk factors? Comparison between large abdominal aortic aneurysm and obstructive non-coronary arterial disease Vascular. 2017;25:629-634.

Poldermans D, Hoeks SE, Feringa HH. Pre-operative risk assessment and risk reduction before surgery. J Am Coll Cardiol 2008;51:1913-1924.

Nowygrod R, Egorova N, Greco G, et al. Trends, complications, and mortality in peripheral vascular surgery. J Vasc Surg 2006;43:205-216.

Sarac TP, Bannazadeh M, Rowan AF, et al. Comparative predictors of mortality for endovascular and open repair of ruptured infrarenal abdominal aortic aneurysms. Ann Vasc Surg 2011;25:461-468.

Dunkelgrun M, Welten GM, Goei D, et al. Association between serum uric acid and perioperative and late cardiovascular outcome in patients with suspected or definite coronary artery disease undergoing elective vascular surgery. Am J Cardiol 2008;102:797-801.

Hoit BD. Left Atrial Size and Function: Role in Prognosis. JACC 2014;63:493-505.

Scali S, Bertges D, Neal D, et al. Heart rate variables in the Vascular Quality Initiative are not reliable predictors of adverse cardiac outcomes or mortality after major elective vascular surgery. J Vasc Surg 2015;62:710-720.

Payne CJ, Payne AR, Gibson SC, Jardine AG, Berry C, Kingsmore DB. Is there still a role for preoperative 12-lead electrocardiography? World J Surg 2011;35:2611-2616.

Anantasit N, Boyd JH, Russell JA, Fjell CD, Lichtenstein SV, Walley KR. Prolonged QTc affects short-term and long-term outcomes in patients with normal left ventricular function undergoing cardiac surgery. J Thorac Cardiovasc Surg 2014;14:1627-1633.

Landesberg G, Einav S, Christopherson R, et al. Perioperative ischemia and cardiac complications in major vascular surgery: importance of the preoperative twelve-lead electrocardiogram. J Vasc Surg 1997;26:570-578.

Lorell BH, Carabello BA. Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation 2000;102:470-479.

Genovese EA, Fish L, Chaer RA, Makaroun MS, Baril DT. Risk stratification for the development of respiratory adverse events following vascular surgery using the Society of Vascular Surgery's Vascular Quality Initiative. J Vasc Surg 2017;65:459-470.

Wallaert JB, Nolan BW, Adams J, et al. The impact of diabetes on postoperative outcomes following lower-extremity bypass surgery J Vasc Surg. 2012;56:1317-1323.

Stather PW, Sidloff D, Dattani N, Choke E, Bown MJ, Sayers RD. Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm. Br J Surg 2013;100:863-872.

Schermerhorn ML, O’Malley JA, Jhaveri A, Cotteril P, Pomposelli F, Landon BE. Endovascular vs Open Repair of Abdominal Aortic Aneurisms in the Medicare population N Engl J Med. 2008;358:464-474.

Cronenwett JL, Likosky DS, Russell MT, Eldrup-Jorgensen J, Stanley AC, Nolan BW. A regional registry for quality assurance and improvement: The Vascular Study Group of Northern New England (VSGNNE). J Vasc Surg 2007;46:1093-1102.

Wu TY, Anderson NE, Barber PA. Neurological complications of carotid revascularization. J Neirol Neurosurg Psychiatry 2012;83:543-550.

Ferrer C, Cao P, De Rango P, et al. A propensity-matched comparison for endovascular and open repair of thoracoabdominal aortic aneurysms. J Vasc Surg 2016;63:1201-1207.

Sharifpour M, Moore LE, Shanks AM, Didier TJ, Kheterpal S, Mashour GA. Incidence, predictors, and outcomes of perioperative stroke in noncarotid major vascular surgery. Anesth Analg 2013;116:424-434.

Stoneham M, Thompson JP. Arterial pressure management and carotid endarterectomy. Br J Anaesth 2009;102:442-452.

Jackson RS, Black JH 3rd, Lum YW, et al. Class I obesity is paradoxically associated with decreased risk of postoperative stroke after carotid endarterectomy. J Vasc Surg. 2012;55:1306-1312.

van Kuijk JP, Schouten O, Flu WJ, den Uil CA, Bax JJ, Poldermans D. Perioperative blood glucose monitoring and control in major vascular surgery patients. Eur J Vasc Endovasc Surg 2009;38:627-634.

Valentine RJ, Hagino RT, Jackson MR, Kakish HB, Bengtson TD, Clagett, GP. Gastrointestinal complications after aortic surgery. J Vasc Surg 1998;28:404-411.

Ghadimi K, Quiñones QJ, Karhausen JA. Identifying Predictors of Gastrointestinal Complications After Cardiovascular Surgery: How Do We Digest the Data? J Cardiothorac Vasc Anesth 2017;31:1275-1277.

Montán C, Wannberg M, Holst J, Wahlgren CM. Perioperative haemorrhage in endovascular abdominal aneurysm repair affects outcome. Eur J Vasc Endovasc Surg 2013;46:87-92.

Maldonado TS, Rockman CB, Riles E, et al. Ischemic complications after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2004;40:703-709.

Bredahl K, Jensen LP, Schroeder TV, Sillesen H, Nielsen H, Eiberg JP. Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease. J Vasc Surg 2015;62:75-82.