Complications of Vascular Complications of Vascular AnastomosisAnastomosis

Badr AljabriBadr Aljabri MD, FRCSC MD, FRCSC

Associate Professor and Consultant Associate Professor and Consultant Vascular Surgeon, KKUHVascular Surgeon, KKUH

Anastomotic bleedingAnastomotic bleeding

Needle hole bleeding.Needle hole bleeding.

- more common with PTFE - more common with PTFE grafts.grafts.

- Rx: Local haemostatic agents.- Rx: Local haemostatic agents.

Reverse systemic heparin Reverse systemic heparin effect.effect.

AnastomoticAnastomotic bleeding bleeding

Suture line bleeding.Suture line bleeding.

- Rx: Simple or U-shaped suture at - Rx: Simple or U-shaped suture at the defect.the defect.

tying should be with non-tying should be with non-Pulsetile flow.Pulsetile flow.

Anastomotic Anastomotic PsudoaneurysmPsudoaneurysm

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

Patient Factors1. Native Artery Disease.2. Infection.3. Smoking4. Hypertension.5. Healing complications ( Seroma, Hematoma)

Material Factors1. Graft Defect2. Suture Degradation or

breakage.3. Prosthetic graft- arterial

wall compliance mismatchTechnical Factors1. Inadequate suture bites.2. Excessive tension.3. Joint Motion.4. Redo Procedure.5. Endarterectomy.

Anastomotic stenosisAnastomotic stenosis

Early : Technical.Early : Technical.

1-18 months: Intimal hyperplasia.1-18 months: Intimal hyperplasia.

> 18 months: Progression of atherosclerosis.> 18 months: Progression of atherosclerosis.

Graft thrombosisGraft thrombosisEarly1. Technical (kink, missed valve, AV fistula,

intimal flap)2. Poor choice of inflow or outflow sites.3. Insufficient runoff.4. Ongoing or progression of soft tissue

infection5. Low circulatory volume.6. Hypercoagulable state.

IntermediateIntimal Hyperplasia (1 month -18 months)

Late 1. Progression of Atherosclerosis.2. Degenerative lesions in the graft

ThrombectomyThrombectomy

Thank youThank you