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The perioperative care of vascular surgery patients, is an increasingly complex and challenging task for anesthesiologists. These patients are often elderly, frail and suffering from multiple chronic disease states. Their comorbidities frequently dominate their perioperative medical course and remain prominent in their postoperative medical care. Accordingly, these high-risk patients require appropriate patient selection and preoperative medical optimization. Meticulous intraoperative anesthetic management followed by experienced and diligent postoperative care helps mitigate end-organ ischemia and ensure successful outcomes.
This issue of Anesthesiology Clinics is devoted to the perioperative medical and surgical management of the patient presenting with vascular disease. We have examined the full spectrum of care for these patients, beginning with the preoperative evaluation and continuing through the critical care considerations following all of the major vascular surgical procedures. We also discusses the optimal medical management of these complicated patients, with a focus on the recent literature that will serve as an evidence-based framework for the future clinical treatment of these patients.
Specific areas of clinical concern related to the anesthetic and surgical management of the vascular patient are examined in detail. Regional anesthesia and its importance to the safe and efficient management of the vascular surgical patient is described, including an overview of the regional techniques frequently associated with vascular surgical procedures. The perioperative management of lower extremity revascularization is reviewed, along with a discussion of the significant comorbidities encountered in this patient population. Evolving intraoperative anesthetic management concepts are examined for both carotid endarterectomy and combined coronary artery bypass grafting and carotid endarterectomy. This issue also presents a surgical perspective on the modern-day management of complex abdominal aneurysms.
We hope you find this edition of Anesthesiology Clinics educational and enjoyable. Thank you for the privilege to facilitate the care of your vascular surgery patients.