Editing Open AAA repair (section)

== Complications ==

* Early
** Cardiac
*** Up to 10%
*** Risk factors:
**** Recent MI, old age, diabetes, poor functional status, arrhythmia, or CCF
*** Ensure patients are on aspirin, statin, beta blockers (aim HR< 60, BP <100
** Pulmonary
*** Periop smoking cessation, optimal bronchodilator therapy, chest physio
*** Delayed extubation if more complex repair involving higher proximal aortic control
*** 17% get pneumonia
** Renal
*** AKI rate is 10%-20%
*** Consider failed renal artery reconstruction or cholesterol embolization
*** Close attention to volume status 
** Colonic ischaemia
*** 0.2-6%
**** 4% for tube grafts
**** 2.7% for aorto-iliac grafts
**** 22% for an aortobifemoral graft
*** Operative risk factors:
**** Ligation of IMA
**** Failure to revascularise hypogastric arteries
*** Patient factors:
**** Pre-existing iliofemoral occlusive disease
**** Previous colonic resection
*** Signs:
**** Early post-op diarrhoea
**** Melaena
**** '''Haematochaezia'''
*** Investigation
**** Flex sig/colonoscopy
**** CT
*** Management
**** Aggressively resuscitatied
**** Broad-spectrum Abx
**** Partial-thickness ischaemia/stable patient: conservative. Mostly doesn't progress to full-thickness necrosis, but still can.
**** Full-thickness ischaemia/peritonitic/unstable: urgent laparotomy and bowel resection. Mortality 55%. Thorough assessment of IMA - if vigorous back-bleeding, probably ok. 
** Lower extremity ischaemia
*** Operative factors:
**** Anastomotic complications
**** Clamp injury
**** Acute thrombosis
**** Acute embolic disease
*** Management:
**** Treat the cause
**** All the above causes need intervention
** Spinal cord ischaemia
*** Extremely rare
*** Extent of proximal coverage of aorta is the biggest risk factor
*** CSF drainage and pelvic revascularisation are main treatments
** Venous thrombosis
*** Clinically rare due to systemic anticoagulation

[[Category:Vascular]]