Anesthesia for Lower Extremity Bypass
Due to the complexity of the procedures and the multiple complex comorbidities of the patients, vascular anesthesia is one of the more challenging sub-specialty fields within the practice of anesthesiology. Patients within this population are frequently elderly, suffer from multiple medical conditions and often present for surgery in emergent or urgent scenarios that afford little time for preoperative evaluation and medical optimization. Analysis of data from the National Surgical Quality Improvement Program (NSQIP) database, determined that vascular surgery carries an absolute risk of 30-day mortality of 3% . The VISION study confirms these results demonstrating in 15,000 patients undergoing major non-cardiac surgery, vascular surgery is a predictor of 30-day mortality . These reviews highlight that vascular surgery is inherently high risk, and as such carries a significant probability of perioperative and post-operative morbidity and mortality.
Vascular surgery encompasses a vast array of procedures spanning multiple vessels in the body, with a large portion of procedures involving the lower extremities. Lower extremity revascularization in particular, is indicated as a result of a variety of disease states, the most common being peripheral arterial disease (PAD). PAD is an increasing problem across the globe, affecting over 200 million people worldwide . Due in large part to an overall increase in life expectancy, the number of patients expected to encounter vascular disease is on the rise. From 2000 to 2010, the global population saw an estimated 23.5% increase in the number of people suffering from PAD. While this number is skewed by increasing numbers of cases in lower-income countries, the rise in PAD in high-income countries such as the United States is not insignificant, with an estimated 13.1% in the same time period . This chapter presents a systematic approach to preoperative, intraoperative, and post-operative management of patients undergoing lower extremity revascularization to aid anesthesiologists in providing optimal care for this medically diverse and exigent patient population.
KeywordsLower extremity vascular surgery Pre-anesthesia evaluation of vascular surgery patients Peripheral arterial disease Coronary artery disease Lower extremity vascular anatomy Diabetes mellitus Perioperative medication management Regional vs. general anesthesia in vascular surgery
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