Journal «Angiology and Vascular Surgery» • 

2019 • VOLUME 25 • №1

Bleedings after reconstructive operations
on the aorta, its branches, and peripheral arteries
(on materials of the Department of Vascular Surgery A.N. Bakulev
ICVS of the Academy of Medical Sciences of the USSR, 1961-1983)

Shchelkunov N.B.1, Arakelyan V.S.2, Glyantsev S.P.2

1) Bryansk Regional Hospital №1, Bryansk,
2) A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia

The authors retrospectively analysed episodes of bleeding after reconstructive operations on the aorta, its branches, and peripheral arteries. The sources of information were the archival medical records of the Department of Vascular Surgery of formerly the Institute of Cardiovascular Surgery named after A.N. Bakulev under the USSR Academy of Medical Sciences (now known as the National Medical Research Centre of Cardiovascular Surgery named after A.N. Bakulev) over the period from 1961 to 1983. A total of 3,787 operations on the aorta and arteries had been performed over that time period. Bleedings were observed in 170 cases (4.5% of all interventions), with the mortality rate amounting to 25.3%. Of these, 72 bleedings (42.3%) were primary, to have developed from anastomoses or sutures of the artery, with 38 (22.3%) being secondary (arrosive) and 10 (5.9%) related to hypocoagulation. In the remaining 50 (29.4%) episodes, the blood had leaked from tissues (en masse). Of these, no source of bleeding had been identified in 8 (4.7%) cases.

The subjects of investigation were the terms of bleeding onset, localization, causes, dependence from suture material. The authors suggested a tentative classification of postoperative bleeding. It was determined that 50.6% of these events had developed within the first 24 postoperative hours. Primary bleedings were found to have more often occurred from sutures of the thoracic aorta (58.3%) and arrosive ones from the femoral artery (60%). The causes of primary bleedings were determined to be as follows: cuts of the vascular wall by suture material (66.7%) or needle entry holes (15%), defects between sutures of an anastomosis (14%), defects of an autovein in the area of an anastomosis (2.8%), separation of fibers of the graft in the area of an anastomosis (1.4%). Also analysed are the methods of final arrest of haemorrhage.

The authors believe that this historical experience may be used to improve qualification of vascular surgeons.

KEY WORDS: operations on the aorta and arteries, postoperative bleeding, retrospective analysis, Institute of Cardiovascular Surgery named after A.N. Bakulev under the USSR Academy of Medical Sciences.

P. 151

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