Complications - Popliteal artery aneurysm: Resection and revascularization with greater saphenous vein graft (posterior access)

Venous bleeding

Since both the popliteal vein and the epifascial veins and their lateral branches parallel and often encircle the popliteal artery, any injury to the veins may result in troublesome bleeding.

• Heavy venous bleeding → Compression and precise suture

As preemptive measure, clean dissection of the popliteal artery with division of the transverse veins and gentle mobilization of the major deep veins is recommended. If necessary, the veins may also be looped with vessel loops and retracted to the side.

Caution: Marked impairment of venous return due to ligation of multiple veins increases the risk of postoperative occlusion of the revascularized popliteal artery.

Anastomotic stenosis

• Dilation, surgical revision if needed

Peripheral embolization

• Embolectomy

Nerve damage

• Particularly in the posterior approach, careful dissection can prevent possible nerve injury

Secondary bleeding

• Cause: Technical flaws (suture failure; slipped ligatures; inadequate hemostasis; overlooked ligature of lateral branches of autologous veins, etc.), needle track bleeding
• Diagnostic workup: Clinical findings
• Treatment: Revision surgery
• Prevention: Careful atraumatic, anatomically correct surgical technique, painstaking hemostasis

Hematoma

• Broad indication for evacuation, as hematomas are a good breeding ground for secondary infections and may result in compartment syndrome by compression of adjacent structures.

Early occlusion (< 30 days post-surgery)

• Cause: Technical—iatrogenic
• Diagnostic work-up: Color-coded duplex sonography, CTA
• Treatment: Revision surgery

Late occlusion (> 30 days post-surgery)

• Cause: Stenotic anastomosis, neointimal hyperplasia
• Diagnostic work-up: Color-coded duplex sonography, CTA
• Treatment: Revision surgery, endovascular procedures, hybrid procedures (combined open + endovascular)

Wound infection

• Cause: Local; systemic; hematogenic; lymphogenic
• Diagnostic work-up: Symptoms, lab panel
• Management: Wound revision with debridement, lavage, possibly negative pressure wound therapy (NPWT); antibiotics according to antimicrobial resistance screening
• Prevention: Careful atraumatic, anatomically correct surgical technique, painstaking hemostasis