Respiratory Complications and Aortoiliac Surgery: A Retrospective Review from 105 Consecutive Conventional Revascularizations

Abstract

The purposes of this study, in view of previous controversial reports, were to assess retrospectively the frequency and severity of respiratory complications in patients undergoing aortoiliac surgery and to delineate the more significant preoperative risk factors. Excluding extraanatomic procedures, the review of 105 consecutive revascularizations, performed between June 1993 and December 1994, included the study of classic perioperative parameters; preoperative general conditions; and risk factors of the patients: age, sex, weight, diabetes, smoking habits, hypertension, coronary disease, and surgical antecedents with previous revascularizations; and type of arterial lesions: aortoiliac occlusive disease (AOID) or aneurysm. More specific perioperative studies included previous respiratory disease history evaluation, chest radiography, pulmonary function tests (PFT) analysis, and blood gas results. Prior to intervention the American Society of Anesthesiologists (ASA) class of patients was ascertained. Intraoperative techniques and conditions including types of incisions and revascularizations, methods of anesthetic monitoring, anesthetic and intubation times, blood and liquids losses and replacements, postoperative course with intensive care stay, and bacteriologic origin of septic pulmonary complications were also reviewed.

The total perioperative mortality was 1.9% (two of 105), exclusively related to respiratory failures without primary cardiac origin or pulmonary embolism history. Major respiratory complications occured in 22 patients (20.9%), with a preeminence of pneumonia in 13. The total respiratory complications rate with favorable outcome was 19% (20 patients). Deaths occurred in patients with respiratory distress syndrome (one) and pneumonia with multiorgan failure (one). Univariate analysis demonstrated that only preoperative pathologic PFT and ASA classification were associated with postoperative respiratory complications. Major respiratory risks included forced vital capacity (FVC) <50%, forced expiratory volume (FEV) <1 1, and partial pressure of arterial carbon dioxide (Paco₂) >50 mmHg. Questionable risk factors included intubation time, aortic clamp time, crystalloid replacements, and adjunctive epidural analgesia.

Get full access to this article

View all access options for this article.

References

1. Calligaro KD , Azurin DJ , Dougherty MJ , et al: Pulmonary risk factors of elective abdominal aortic surgery. J Vasc Surg 18:914-921, 1993.

2. Svensson LG , Hess KR , Coselli JS , et al: A prospective study of respiratory failure after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg 14:271-282, 1991.

3. Johanson WG Jr , Pierce AK , Sanford JP , et al: Nosocomial respiratory infections with gram-negative bacilli: The signifiance of colonization of the respiratory tract. Ann Intern Med 77:701-706, 1972.

4. Mitchell C , Garrahy P , Peake P : Postoperative respiratory morbidity: Identification and risk factors. Aust N Z J Surg 52:203-209, 1982.

5. Rodriguez JL : Hospital-acquired gram-negative pneumonia in critically ill, injured patients. Am J Surg 165 (suppl. IIA):34S-42S, 1993.

6. Jackson CV : Preoperative pulmonary evaluation. Arch Intern Med 148:2120-2127, 1988.

7. Smith P , Sabiston DC : Surgical management of aortic abdominal aneurysms in patients with severe pulmonary insufficiency. Surg Gynecol Obstet 151:407-411, 1980.

8. Becquemin JP , Piquet J , Becquemin MH , et al: Pulmonary function after transverse or midline incision in patients with obstructive pulmonary disease. Intensive Care Med 11:247-251, 1985.

9. Sicard GA , Freeman MB , Van Der Woude JC , et al: Comparison between transabdominal and retroperitoneal approach for reconstruction of the infrarenal abdominal aorta. 00:000-000, 0000.

10.

10. Cambria RP , Brewster DC , Abbott WM , et al: Transperitoneal versus retroperitoneal approach for aortic reconstruction: A randomized prospective study. J Vasc Surg 11:314-325, 1990.

11.

11. Blumenberg RM , Skudder PA , Gelfand ML , et al: Retroperitoneal nonresective staple exclusion of abdominal aortic aneurysms: Clinical outcome and fate of the excluded abdominal aortic aneurysms. J Vasc Surg 21:623-634, 1995.

12.

12. Fantini GA , Galadeta D , Silane MF , et al: Neutrophil leukotriene generation and pulmonary dysfunction following abdominal aortic repair(Meeting Abstracts). J Vasc Surg 17:1132-1132, 1993.