Complications - Alloplastic carotid-subclavian bypass for left subclavian artery stenosis

Immediate Closure of the Bypass

• surgical revision, possibly new graft; if possible, the anastomoses should not be disconnected

perioperative stroke

• Duplex sonography/spiral angio-CT -> clarify cause, exclude intracranial embolization
• in case of local technical problem, surgical revision
• in case of intracranial occlusions, conservative
• Thrombolysis contraindicated in neck interventions

Nerve injury

• e.g., N. phrenicus -> suture

Prevention of neural damage

• secure mastery of the anatomy
• careful preparation for identification and display of neural structures in the surgical area
• anticipate atypical anatomical variants and prepare them particularly carefully
• no coagulation of bleedings from the perineurium
• avoid compression of nerves by hooks and retractors

Bypass Occlusion

• surgical revision

Hematomas/Larger Postoperative Bleeding

• surgical revision

Wound Infection

• Therapy of early and late superficial/deep infections of the neck soft tissues follows usual standards
• open and drain putrid infections early, targeted antibiotic therapy according to antibiogram, if necessary VAC therapy
• in case of uncontrollable infection, if possible remove foreign material and reconstruct with autologous vein (reversed)

Lymph Fistula

• conservative treatment attempt
• if necessary, surgical revision