Systemic Complications: Neurologic

Due to proximity of nerves to arteries and veins, it is imperative for vascular surgeons to be familiar with the anatomy of nervous structures during any vascular exposure. The nerve injuries can be either ischemic or traumatic. A rich network of vasa nervosum usually provides oxygen and nutrients to nerves and makes then resistant to hypoxemia. However, prolonged or persistent hypoxemia leads to anaerobic metabolism and resultant acidosis which may result in irreversible depolarization and permanent damage to the nerves. Traumatic nerve injuries during vascular exposures can cause permanent damage to the nerves and are preventable by using meticulous surgical technique. The most common nerves damaged during carotid exposure are vagus, hypoglossal and marginal mandibular nerves; during supraclavicular exposures are phrenic and long thoracic nerves; during upper extremity vascular exposures are median, ulnar, medial antebrachial cutaneous and radial nerves and during lower extremity exposures are lateral femoral cutaneous, obturator, femoral, anterior cutaneous femoral, saphenous nerves, sural, sciatic, tibial and peroneal nerves. This chapter covers the relevant anatomy of the vascular structures and associated nerve structures during common vascular exposures.