Emergencies for the Vascular Surgeon

Abstract

Systemic autoimmune diseases can result in a variety of vascular ­abnormalities, usually due to either vessel wall inflammation or clotting abnormalities. Acute vascular emergencies secondary to these abnormalities commonly occur due to thrombosis with subsequent ischemia or infarction, aneurysm formation, or hemorrhage. A range of vessels can be affected depending on the type and severity of the autoimmune disease, and patients can present with a range of symptoms to vascular surgeons in the emergency setting. Medical management of the underlying systemic disease is the preferred choice of treatment in autoimmune vascular emergencies, but life-/limb-threatening ischemia or hemorrhage of the cerebrovascular/brachiocephalic, upper limb, renal, gastrointestinal, or lower limb vessels often requires emergency vascular surgery. Traditional open vascular surgery is high-risk, especially in this group of patients, and is rapidly being replaced by less invasive endovascular procedures, including percutaneous transluminal balloon angioplasty/stenting, mechanical thrombectomy, and thrombolysis. Emergency endovascular repair of ruptured aneurysms/dissections is now also performed routinely in specialist vascular centers. A multidisciplinary team approach is essential in the treatment of patients with complex and acute autoimmune diseases and should involve ­specialist physicians, hematologists, and interventional radiologists as well as vascular and ­endovascular surgeons.