A nurse is assessing the neurovascular of a client who has returned to the surgical nursing unit 4 hours ago after undergoing an aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. The nurse interprets that the neurovascular status is:
A. Normal because of increased blood flow through the leg.
B. Slightly deteriorating and should be monitored for another hour.
C. Moderately impaired, and the surgeon should be called.
D. Adequate from an arterial approach, but venous complications are arising.
Correct Answer: A. Normal because of increased blood flow through the leg
An expected outcome of surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow. Aortoiliac occlusive disease can contribute to lower extremity ischemic symptoms necessitating intervention. Symptoms of patients with aortoiliac occlusive disease may include claudication, rest pain of the lower extremities, or ischemic ulcer formation on lower extremities due to inadequate blood flow.
Option B: As with any surgical procedure, there exists a risk of bleeding or infection. In addition, there is a risk of wound infection, hematoma. Complications that result in significant morbidities include MI, renal dysfunction, and respiratory dysfunction. Late complications include hernias, graft thrombosis, and graft pseudoaneurysms, graft infections, aortoenteric fistulas further discussed below.
Option C: Most frequently, (in 50% of cases), cardiac ischemia is responsible for death related to aortic reconstruction, which is because there are seldom patients with normal coronary arteries. Hence the importance of pre-operative screening and treatment and cardiac comorbidities. Mortality related to cardiac death following surgical intervention is 1% to 2.5% in some centers.
Option D: Another common complication following surgery is renal insufficiency. This condition is typically a result of prolonged ischemia after clamping suprarenal, embolization secondary to clamping, hypoperfusion, hypovolemia, or intrinsic renal artery disease. Often, this post-operative complication directly relates to the patient’s preoperative cardiac and renal function.
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