Vascular surgery carries an increased risk of a variety of complications in the immediate and extended postoperative periods. Major vascular operations, such as thoracoabdominal aortic aneurysm repairs and limb revascularizations, are commonly associated with prolonged operative time, ischemic reperfusion injuries, large blood losses, and systemic inflammatory response syndrome. Additionally, vascular patients usually present with a high burden of comorbidities. These factors increase the risk of multiple organ systems failing postoperatively. Myocardial injury, postoperative pulmonary complications, acute kidney injury, and neurovascular complications are relatively common and have been shown to increase morbidity and mortality. Close monitoring and an appropriate level of care ensure a safe transition into the postoperative phase. Recent data suggest that risk stratification with modern diagnostic tools and laboratory tests using sensitive biomarkers play pivotal roles in the early detection of deteriorating organ function and initiation of timely intervention. Evidence-based postoperative management guidelines and care bundles (e.g., prehabilitation, enhanced screening for myocardial injury, lung-protective ventilator management, kidney protection strategies, and enhanced recovery protocols) show promise in preventing, mitigating, and effectively treating complications with an overarching goal of optimizing postoperative outcomes and ensuring that patients recover successfully.

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