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

B. Age, MD

T. Streichenberger, MD

J. M. Zabot, MD

P. Lepine, MD

Rhone-Alpes Association of Private Vascular Surgeons, Grenoble, France

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.

Vascular and Endovascular Surgery, Vol. 33, No. 6, 677-682 (1999)
DOI: 10.1177/153857449903300615


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