Skip to main content
SpringerLink
Log in

Vascular Surgery

  • Reference work entry
  • First Online:
Principles and Practice of Geriatric Surgery

  • 524 Accesses

Abstract

Cardiovascular diseases are the most common cause of morbidity and mortality in the world and account for 50% of deaths in people aged 65 and older. While there are many known modifiable risk factors, aging is as an independent and non-modifiable risk factor for worse outcomes in vascular diseases. The geriatric population is unique in their physiologic state, tolerance to stressors with serious risks to morbidity and mortality. Hence, it is essential for vascular surgeons and specialists in vascular interventions to consider the broader picture in older patients. This chapter delves into the geriatric-specific considerations for common vascular disease states. The first section studies the various preoperative risk factors and anesthesia considerations in older adults. Then, we dive into the various vascular maladies prevalent in the older population and their management approach including peripheral artery disease (PAD), carotid artery stenosis, and abdominal aortic aneurysms. Vascular atherosclerotic disease contributes to significantly high morbidity and economic burden in this cohort. Clinicians must carefully consider the decision to intervene, timing of intervention, as well as use of endovascular techniques for treatment of vascular disease. There is growing consensus to include frailty into the surgical workflow towards better planning for high risk patients. Preoperative frailty assessment using geriatric-specific tools could guide shared decision making and utilization of palliative services surrounding vascular care towards reducing morbidity and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 649.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 949.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Villella E, Cho JS (2015) Effect of aging on the vascular system plus monitoring and support. Surg Clin North Am 95(1):37–51

    PubMed  Google Scholar 

  2. Partridge JS, Fuller M, Harari D, Taylor PR, Martin FC, Dhesi JK (2015) Frailty and poor functional status are common in arterial vascular surgical patients and affect postoperative outcomes. Int J Surg (Lond, Engl) 18:57–63

    Google Scholar 

  3. Partridge JS, Harari D, Martin FC et al (2017) Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. Br J Surg 104:679–687

    CAS  PubMed  Google Scholar 

  4. Ellis G, Whitehead MA, Robinson D, O'Neill D, Langhorne P (2011) Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ (Clin Res ed) d6553:343

    Google Scholar 

  5. Moreira CC, Farber A, Kalish JA et al (2016) The effect of anesthesia type on major lower extremity amputation in functionally impaired elderly patients. J Vasc Surg 63(3):696–701

    PubMed  Google Scholar 

  6. Singh N, Sidawy AN, Dezee K et al (2006) The effects of the type of anesthesia on outcomes of lower extremity infrainguinal bypass. J Vasc Surg 44(5):964–968. discussion 968–970

    PubMed  Google Scholar 

  7. Siracuse JJ, Gill HL, Parrack I et al (2014) Variability in anesthetic considerations for arteriovenous fistula creation. J Vasc Access 15(5):364–369

    PubMed  Google Scholar 

  8. Steunenberg SL, Faber MJ, Raats JW, Mulder PG, van der Laan L (2016) Life expectancy in nonagenarians suffering from critical limb ischemia. Ann Vasc Surg 36:218–225

    PubMed  Google Scholar 

  9. Savji N, Rockman CB, Skolnick AH et al (2013) Association between advanced age and vascular disease in different arterial territories: a population database of over 36 million subjects. J Am Coll Cardiol 61(16):1736–1743

    PubMed  Google Scholar 

  10. Mozaffarian D, Benjamin EJ, Go AS et al (2016) Heart disease and stroke Statistics-2016 update: a report from the American Heart Association. Circulation 133(4):e38–e360

    PubMed  Google Scholar 

  11. Hirsch AT, Hartman L, Town RJ, Virnig BA (2008) National health care costs of peripheral arterial disease in the Medicare population. Vasc Med (Lond, Engl) 13(3):209–215

    Google Scholar 

  12. Mahoney EM, Wang K, Keo HH et al (2010) Vascular hospitalization rates and costs in patients with peripheral artery disease in the United States. Circ Cardiovasc Qual Outcomes 3(6):642–651

    PubMed  Google Scholar 

  13. Biasi L, Patel SD, Lea T et al (2017) Complex infrapopliteal revascularization in elderly patients with critical limb ischemia: impact of multidisciplinary integrated care on mid-term outcome. J Cardiovasc Surg (Torino). 58(5):665–673

    Google Scholar 

  14. Conte MS, Pomposelli FB, Clair DG et al (2015) Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg 61(3 Suppl):2s–41s

    PubMed  Google Scholar 

  15. USPSTF (2019) Final recommendation statement: peripheral artery disease and cardiovascular disease: screening and risk assessment with the ankle-brachial index. July 2019. US Preventive Services Task Force

    Google Scholar 

  16. Adkar SS, Turley RS, Benrashid E, Lagoo S, Shortell CK, Mureebe L (2017) Perioperative optimization of geriatric lower extremity bypass in the era of increased performance accountability. Ann Vasc Surg 38:248–254

    PubMed  Google Scholar 

  17. Hirsch AT, Haskal ZJ, Hertzer NR et al (2006) ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA task force on practice guidelines (writing committee to develop guidelines for the Management of Patients with Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic inter-society consensus; and vascular disease foundation. Circulation 113(11):e463–e654

    PubMed  Google Scholar 

  18. Abdel-Kader K, Palevsky P (2009) Acute kidney injury in the elderly. Clin Geriatr Med 25(3):331–358

    PubMed  PubMed Central  Google Scholar 

  19. Hobaus C, Herz CT, Obendorf F et al (2017) Center-based patient care enhances survival of elderly patients suffering from peripheral arterial disease. Ann Med 49(4):291–298

    PubMed  Google Scholar 

  20. Braithwaite BD, Davies B, Birch PA, Heather BP, Earnshaw JJ (1998) Management of acute leg ischaemia in the elderly. Br J Surg 85(2):217–220

    CAS  PubMed  Google Scholar 

  21. Conte MS, Pomposelli FB (2015) Society for Vascular Surgery Practice guidelines for atherosclerotic occlusive disease of the lower extremities management of asymptomatic disease and claudication. Introduction. J Vasc Surg 61(3 Suppl):1s

    PubMed  Google Scholar 

  22. Ahimastos AA, Pappas EP, Buttner PG, Walker PJ, Kingwell BA, Golledge J (2011) A meta-analysis of the outcome of endovascular and noninvasive therapies in the treatment of intermittent claudication. J Vasc Surg 54(5):1511–1521

    PubMed  Google Scholar 

  23. Pandey A, Banerjee S, Ngo C et al (2017) Comparative efficacy of endovascular revascularization versus supervised exercise training in patients with intermittent claudication: meta-analysis of randomized controlled trials. JACC Cardiovasc Interventions 10(7):712–724

    Google Scholar 

  24. Bedenis R, Stewart M, Cleanthis M, Robless P, Mikhailidis DP, Stansby G (2014) Cilostazol for intermittent claudication. Cochrane Database Syst Rev 10:Cd003748

    Google Scholar 

  25. Bredahl K, Jensen LP, Schroeder TV, Sillesen H, Nielsen H, Eiberg JP (2015) Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease. J Vasc Surg 62(1):75–82

    PubMed  Google Scholar 

  26. Hamdi A, Al-Zubeidy B, Obirieze A et al (2016) Lower extremity arterial reconstruction in octogenarians and older. Ann Vasc Surg 34:171–177

    PubMed  PubMed Central  Google Scholar 

  27. Shirasu T, Hoshina K, Nishiyama A et al (2016) Favorable outcomes of very elderly patients with critical limb ischemia who undergo distal bypass surgery. J Vasc Surg 63(2):377–384

    PubMed  Google Scholar 

  28. Uhl C, Hock C, Ayx I, Zorger N, Steinbauer M, Topel I (2016) Tibial and peroneal bypasses in octogenarians and nonoctogenarians with critical limb ischemia. J Vasc Surg 63(6):1555–1562

    PubMed  Google Scholar 

  29. Farber A, Rosenfield K, Siami FS, Strong M, Menard M (2019) The BEST-CLI trial is nearing the finish line and promises to be worth the wait. J Vasc Surg 69(2):470–481.e472

    PubMed  Google Scholar 

  30. Shiraki T, Iida O, Takahara M et al (2016) The geriatric nutritional risk index is independently associated with prognosis in patients with critical limb ischemia following endovascular therapy. Eur J Vasc Endovasc Surg 52(2):218–224

    CAS  PubMed  Google Scholar 

  31. Miller AP, Huff CM, Roubin GS (2016) Vascular disease in the older adult. J Geriatric Cardiol: JGC 13(9):727–732

    Google Scholar 

  32. Stern JR, Wong CK, Yerovinkina M et al (2017) A meta-analysis of Long-term mortality and associated risk factors following lower extremity amputation. Ann Vasc Surg 42:322–327

    PubMed  Google Scholar 

  33. Lyaker MR, Tulman DB, Dimitrova GT, Pin RH, Papadimos TJ (2013) Arterial embolism. Int J Crit Illn Inj Sci 3(1):77–87

    PubMed  PubMed Central  Google Scholar 

  34. Tosato F, Pilon F, Danieli D, Campanile F, Zaramella M, Milite D (2011) Surgery for acute lower limb ischemia in the elderly population: results of a comparative study. Ann Vasc Surg 25(7):947–953

    PubMed  Google Scholar 

  35. Rothwell PM, Coull AJ, Silver LE et al (2005) Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford vascular study). Lancet (Lond, Engl) 366(9499):1773–1783

    CAS  Google Scholar 

  36. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ (2004) Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet (Lond, Engl) 363(9413):915–924

    CAS  Google Scholar 

  37. Hobson RW 2nd, Howard VJ, Roubin GS et al (2004) Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg 40(6):1106–1111

    PubMed  Google Scholar 

  38. Schmid S, Tsantilas P, Knappich C et al (2017) Risk of Inhospital stroke or death is associated with age but not sex in patients treated with carotid endarterectomy for asymptomatic or symptomatic stenosis in routine practice: secondary data analysis of the Nationwide German statutory quality assurance database from 2009 to 2014. J Am Heart Assoc 6(3):e004764. https://doi.org/10.1161/JAHA.116.004764

  39. Miller MT, Comerota AJ, Tzilinis A, Daoud Y, Hammerling J (2005) Carotid endarterectomy in octogenarians: does increased age indicate “high risk?”. J Vasc Surg 41(2):231–237

    PubMed  Google Scholar 

  40. Rajamani K, Kennedy KF, Ruggiero NJ, Rosenfield K, Spertus J, Chaturvedi S (2013) Outcomes of carotid endarterectomy in the elderly: report from the National Cardiovascular Data Registry. Stroke 44(4):1172–1174

    PubMed  Google Scholar 

  41. Debing E, Van den Brande P. Carotid endarterectomy in the elderly: are the patient characteristics, the early outcome, and the predictors the same as those in younger patients? Surg Neurol 2007;67(5):467–471. discussion 471

    Google Scholar 

  42. Rosenthal D, Rudderman RH, Jones DH et al (1986) Carotid endarterectomy in the octogenarian: is it appropriate? J Vasc Surg 3(5):782–787

    CAS  PubMed  Google Scholar 

  43. Reichmann BL, van Lammeren GW, Moll FL, de Borst GJ (2011) Is age of 80 years a threshold for carotid revascularization? Curr Cardiol Rev 7(1):15–21

    PubMed  PubMed Central  Google Scholar 

  44. Aronow WS (1990) Risk factors for geriatric stroke: identification and follow-up. Geriatrics 45(9):37–40. 43–34

    CAS  PubMed  Google Scholar 

  45. Binaghi F, Fronteddu PF, Putzu V, Cannas F, Pitzus F (1998) Association between carotid lesions evaluated by Doppler color echocardiography and cardiovascular risk factors in the elderly. Preliminary results. Minerva Cardioangiol 46(7–8):217–227

    CAS  PubMed  Google Scholar 

  46. Spannella F, Giulietti F, Buscarini S et al (2016) Os 10-01 prevalence of carotid plaque and role of cardiovascular risk factors in a very elderly population: are atherosclerosis and aging synonyms? J Hypertens 34(Suppl 1). ISH 2016 Abstract Book:e72

    Google Scholar 

  47. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators (1991) Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke stroke and trauma division. Stroke 22(6):816–817

    Google Scholar 

  48. Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK (2011) Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg 54(3):e1–e31

    PubMed  Google Scholar 

  49. Endarterectomy for asymptomatic carotid artery stenosis (1995) Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 273(18):1421–1428

    Google Scholar 

  50. Abbott AL (2009) Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis. Stroke 40(10):e573–e583

    PubMed  Google Scholar 

  51. Marquardt L, Geraghty OC, Mehta Z, Rothwell PM (2010) Low risk of ipsilateral stroke in patients with asymptomatic carotid stenosis on best medical treatment: a prospective, population-based study. Stroke 41(1):e11–e17

    PubMed  Google Scholar 

  52. Markus HS, King A, Shipley M et al (2010) Asymptomatic embolisation for prediction of stroke in the asymptomatic carotid emboli study (ACES): a prospective observational study. Lancet Neurol 9(7):663–671

    PubMed  PubMed Central  Google Scholar 

  53. Howard VJ, Meschia JF, Lal BK et al (2017) Carotid revascularization and medical management for asymptomatic carotid stenosis: protocol of the CREST-2 clinical trials. Int J Stroke 12(7):770–778

    PubMed  PubMed Central  Google Scholar 

  54. Mantese VA, Timaran CH, Chiu D, Begg RJ, Brott TG (2010) The carotid revascularization endarterectomy versus stenting trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke 41(10 Suppl):S31–S34

    PubMed  PubMed Central  Google Scholar 

  55. Howard G, Roubin GS, Jansen O et al (2016) Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials. Lancet (Lond, Engl) 387(10025):1305–1311

    Google Scholar 

  56. Antoniou GA, Georgiadis GS, Georgakarakos EI et al (2013) Meta-analysis and meta-regression analysis of outcomes of carotid endarterectomy and stenting in the elderly. JAMA Surg 148(12):1140–1152

    PubMed  Google Scholar 

  57. Grant A, White C, Ansel G, Bacharach M, Metzger C, Velez C (2010) Safety and efficacy of carotid stenting in the very elderly. Catheter Cardiovasc Interv 75(5):651–655

    PubMed  Google Scholar 

  58. Jalbert JJ, Nguyen LL, Gerhard-Herman MD et al (2015) Outcomes after carotid artery stenting in Medicare beneficiaries, 2005 to 2009. JAMA Neurol 72(3):276–286

    PubMed  Google Scholar 

  59. Lin CM, Chang YJ, Liu CK, Yu CS, Lu HH (2016) First-ever ischemic stroke in elderly patients: predictors of functional outcome following carotid artery stenting. Clin Interv Aging 11:985–995

    PubMed  PubMed Central  Google Scholar 

  60. Brott TG, Hobson RW 2nd, Howard G et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363(1):11–23

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Bengtsson H, Bergqvist D, Sternby NH (1992) Increasing prevalence of abdominal aortic aneurysms. A necropsy study. Eur J Surgy = Acta chirurgica 158(1):19–23

    CAS  Google Scholar 

  62. Chaikof EL, Brewster DC, Dalman RL et al (2009) The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 50(4 Suppl):S2–S49

    PubMed  Google Scholar 

  63. Hocaoglu S, Kaptanoglu E, Hocaoglu S (2007) Low-back pain in geriatric patients: remember abdominal aortic aneurysm! J Clin Rheumatol 13(3):171–172

    PubMed  Google Scholar 

  64. Spangler R, Van Pham T, Khoujah D, Martinez JP (2014) Abdominal emergencies in the geriatric patient. Int J Emerg Med 7:43

    PubMed  PubMed Central  Google Scholar 

  65. Sugawara Y, Takagi A, Sato O et al (1996) Surgical treatment of abdominal aortic aneurysms in octogenarians. Jpn Circ J 60(6):328–333

    CAS  PubMed  Google Scholar 

  66. Chaikof EL, Dalman RL, Eskandari MK et al (2018) The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 67(1):2–77.e72

    PubMed  Google Scholar 

  67. Giles KA, Schermerhorn ML, O'Malley AJ et al (2009) Risk prediction for perioperative mortality of endovascular vs open repair of abdominal aortic aneurysms using the Medicare population. J Vasc Surg 50(2):256–262

    PubMed  PubMed Central  Google Scholar 

  68. Eslami MH, Rybin D, Doros G, Kalish JA, Farber A (2015) Comparison of a vascular study Group of new England risk prediction model with established risk prediction models of in-hospital mortality after elective abdominal aortic aneurysm repair. J Vasc Surg 62(5):1125–1133.e1122

    PubMed  Google Scholar 

  69. Arya S, Kim SI, Duwayri Y et al (2015) Frailty increases the risk of 30-day mortality, morbidity, and failure to rescue after elective abdominal aortic aneurysm repair independent of age and comorbidities. J Vasc Surg 61(2):324–331

    PubMed  Google Scholar 

  70. Suckow BD, Goodney PP, Columbo JA et al (2018) National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients. J Vasc Surg 67(6):1690–1697.e1691

    PubMed  Google Scholar 

  71. Schermerhorn ML, O'Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358(5):464–474

    CAS  PubMed  Google Scholar 

  72. Brady AR, Fowkes FG, Greenhalgh RM, Powell JT, Ruckley CV, Thompson SG (2000) Risk factors for postoperative death following elective surgical repair of abdominal aortic aneurysm: results from the UK small aneurysm trial. On behalf of the UK small aneurysm trial participants. Br J Surg 87(6):742–749

    CAS  PubMed  Google Scholar 

  73. Ballotta E, Da Giau G, Bridda A, Gruppo M, Pauletto A, Martella B (2008) Open abdominal aortic aneurysm repair in octogenarians before and after the adoption of endovascular grafting procedures. J Vasc Surg 47(1):23–30

    PubMed  Google Scholar 

  74. George EL, Chen R, Trickey AW et al (2019) Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms. J Vasc Surg pii: S0741-5214(19)30348-9. https://doi.org/10.1016/j.jvs.2019.01.074

  75. Itoga NK, Rothenberg KA, Suarez P et al (2019) Metformin prescription status and abdominal aortic aneurysm disease progression in the U.S. veteran population. J Vasc Surg 69(3):710–716.e713

    PubMed  Google Scholar 

  76. Baxter BT, Matsumura J, Curci J et al (2016) Non-invasive treatment of abdominal aortic aneurysm clinical trial (N-TA(3)CT): Design of a Phase IIb, placebo-controlled, double-blind, randomized clinical trial of doxycycline for the reduction of growth of small abdominal aortic aneurysm. Contemp Clin Trials 48:91–98

    PubMed  PubMed Central  Google Scholar 

  77. Ghaffarian AA, Foss WT, Donald G et al (2019) Prognostic implications of diagnosing frailty and sarcopenia in vascular surgery practice. J Vasc Surg 70:892–900

    PubMed  Google Scholar 

  78. Steunenberg SL, Te Slaa A, Ho GH, Veen EJ, de Groot HG, van der Laan L (2017) Dementia in patients suffering from critical limb ischemia. Ann Vasc Surg 38:268–273

    PubMed  Google Scholar 

  79. Visser L, Prent A, van der Laan MJ et al (2015) Predicting postoperative delirium after vascular surgical procedures. J Vasc Surg 62(1):183–189

    PubMed  Google Scholar 

  80. Raats JW, Steunenberg SL, de Lange DC, van der Laan L (2016) Risk factors of post-operative delirium after elective vascular surgery in the elderly: a systematic review. Int J Surg (Lond, Engl) 35:1–6

    CAS  Google Scholar 

  81. Mirabelli LG, Cosker RM, Kraiss LW et al (2018) Rapid methods for routine frailty assessment during vascular surgery clinic visits. Ann Vasc Surg 46:134–141

    PubMed  Google Scholar 

  82. Arya S, Varley P, Youk A et al (2019) Recalibration and external validation of the risk analysis index: a surgical frailty assessment tool. Ann Surg. https://doi.org/10.1097/SLA.0000000000003276

  83. Arya S, Long CA, Brahmbhatt R et al (2016) Preoperative frailty increases risk of nonhome discharge after elective vascular surgery in home-dwelling patients. Ann Vasc Surg 35:19–29

    PubMed  Google Scholar 

  84. Kopecky KE, Urbach D, Schwarze ML (2019) Risk calculators and decision aids are not enough for shared decision making. JAMA Surg 154(1):3–4

    Google Scholar 

  85. Ernst KF, Hall DE, Schmid KK et al (2014) Surgical palliative care consultations over time in relationship to systemwide frailty screening. JAMA Surg 149(11):1121–1126

    PubMed  PubMed Central  Google Scholar 

  86. Rocha-Singh KJ, Zeller T, Jaff MR (2014) Peripheral arterial calcification: Prevalence, mechanism, detection, and clinical implications. Catheter Cardiovasc Interv 83(6):E212–E220

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Shipra Arya

  2. Vascular Section, VA Palo Alto Health Care System, Palo Alto, CA, USA

    Shipra Arya

  3. Vascular Surgical Associates, Marietta, Georgia

    Emily Lagergren

  4. Division of Vascular and Endovascular Surgery, Stanford Medicine - VA Palo Alto Health Care System, Palo Alto, CA, USA

    Jordan Stern

Authors
  1. Emily Lagergren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jordan Stern
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shipra Arya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shipra Arya .

Editor information

Editors and Affiliations

  1. VA Connecticut Health Care System, Yale University School of Medicine, West Haven, CT, USA

    Ronnie A. Rosenthal

  2. Weill Cornell Medicine, Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA

    Michael E. Zenilman

  3. Department of Surgery, Sinai Center for Geriatric Surgery, Sinai Hospital, Baltimore, MD, USA

    Mark R. Katlic

Section Editor information

  1. Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA

    Jason Johanning

  2. Duke Medicine, Durham, NC, USA

    Sandhya Lagoo-Deenadayalan

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Lagergren, E., Stern, J., Arya, S. (2020). Vascular Surgery. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-47771-8_39

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-47771-8_39

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-47770-1

  • Online ISBN: 978-3-319-47771-8

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation