Complications of Vascular Anastomosis

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Presentation transcript:

Complications of Vascular Anastomosis Badr Aljabri MD, FRCSC Associate Professor and Consultant Vascular Surgeon, KKUH

Anastomotic bleeding Needle hole bleeding. - more common with PTFE grafts. - Rx: Local haemostatic agents. Reverse systemic heparin effect.

Anastomotic bleeding Suture line bleeding. - Rx: Simple or U-shaped suture at the defect. tying should be with non-Pulsetile flow.

Anastomotic Psudoaneurysm Disruption of the suture line at the anastomosis result in walled off extra- luminal circulation of the blood.

Material Factors Technical Factors Native Artery Disease. Infection. Patient Factors Native Artery Disease. Infection. Smoking Hypertension. Healing complications ( Seroma, Hematoma) Material Factors Graft Defect Suture Degradation or breakage. Prosthetic graft- arterial wall compliance mismatch Technical Factors Inadequate suture bites. Excessive tension. Joint Motion. Redo Procedure. Endarterectomy.

Anastomotic stenosis Early : Technical. 1-18 months: Intimal hyperplasia. > 18 months: Progression of atherosclerosis.

Graft thrombosis Early Intermediate Late Technical (kink, missed valve, AV fistula, intimal flap) Poor choice of inflow or outflow sites. Insufficient runoff. Ongoing or progression of soft tissue infection Low circulatory volume. Hypercoagulable state. Intermediate Intimal Hyperplasia (1 month -18 months) Late Progression of Atherosclerosis. Degenerative lesions in the graft

Thrombectomy

Thank you