Interventions in atherosclerosis: a review for surgeons

For the surgeon, atherosclerosis is defined by a variety of aneurysmal, occlusive, or ulcerated lesions in major arteries. These end-stage lesions often require operative treatment. However, just as advanced atherosclerosis presents complex clinical phenomena, so its earlier stages display many underlying mechanisms promoting lesions. To arrest or control atherosclerosis, the disease must be approached with knowledge about diverse biological processes. These include ceullar and systemic aspects of lipoprotein metabolism, reactions and metabolism of endothelium and smooth muscle cells of the arterial wall, and interaction of platelets with the arterial intima. The chronic nature of this process is such that surgeons are involved intimately with overall management as well as with surgical procedures. We will review underlying biological processes of atherosclerosis as related to interventions in patients with clinically apparent disease.