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Acute Vascular Insufficiency in the Elderly

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Geriatric Trauma and Critical Care

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Abstract

The evolving demographic shift in the United States resulting in increasing numbers of elderly citizens directly impacts all of healthcare. Emergency services now are inundated with geriatric patients who often present with surgical problems complicated by multiple comorbidities. The key to the successful management of surgical emergencies in the elderly is not only early diagnosis and prompt treatment but also aggressive management of multiple pre-existing major health problems. This is especially true in acute ischemia in the elderly. Delay in diagnosis is common in these patients despite the fact that a simple history and physical examination often are sufficient to make the diagnosis. These delays lead to high morbidity and mortality because the elderly frequently have multiple serious comorbidities and limited reserve to tolerate the sequelae of ischemia. The goal of this chapter is to provide a useful approach to the management of acute vascular insufficiency in the elderly for the acute care general surgeon. This review includes extremity and abdominal acute arterial and venous occlusive diseases and presents algorithms and checklists to help organize and direct diagnosis and management. Illustrative case presentations of each major etiology of acute vascular insufficiency conclude this chapter and provide an integration of the key elements of successful early diagnosis and prompt treatment.

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  1. Department of Surgery, UCSD School of Medicine, Scripps Mercy Hospital, 4077 5th Avenue MER-62, San Diego, CA, 92103, USA

    Michael J. Sise MD, FACS

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  1. Michael J. Sise MD, FACS
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Correspondence to Michael J. Sise MD, FACS .

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  1. Department of Surgery, Stritch School of Medicine Loyola University of Chicago Edward Hines, Jr. Veterans Administration Medical Center, Maywood, Illinois, USA

    Fred A. Luchette

  2. Professor of Surgery, Hofstra School of Medicine Medical Director for Surgical and Perioperative Services, Southside Hospital/Northwell Health, Bay Shore, New York, USA

    Jay A. Yelon

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Sise, M.J. (2017). Acute Vascular Insufficiency in the Elderly. In: Luchette, F., Yelon, J. (eds) Geriatric Trauma and Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-48687-1_20

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