[Multimorbid vascular patients-do endovascular techniques expand the limits?]

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Geriatric Cardiology

Background:

• Multimorbid vascular patients present complex treatment challenges.
• Endovascular techniques have evolved, impacting treatment paradigms.
• Assessing the expanded role of endovascular methods in diverse vascular conditions is crucial.

Purpose of the Study:

• To evaluate whether endovascular techniques extend treatment options for multimorbid vascular patients.
• To determine the indications for endovascular versus open procedures based on vascular disease characteristics.
• To analyze the impact of endovascular interventions on perioperative risk and patient selection.

Main Methods:

• Review of current literature on endovascular techniques in vascular surgery.
• Analysis of treatment outcomes for carotid stenosis, abdominal aortic aneurysms, and critical limb ischemia.
• Comparison of endovascular versus open surgical approaches in specific patient cohorts.

Main Results:

• Conservative management is preferred for asymptomatic carotid stenosis in patients with limited life expectancy.
• Endovascular treatment is indicated for symptomatic carotid stenosis in specific anatomical scenarios.
• Endovascular repair of intact abdominal aortic aneurysms (AAA) reduces perioperative risk, expanding indications in suitable patients.
• Endovascular repair of ruptured AAAs may increase treatment rates, though evidence is not definitive.
• Endovascular techniques have largely replaced open bypass surgery for critical limb ischemia, reducing perioperative morbidity, especially in frail elderly patients.

Conclusions:

• Endovascular techniques offer valuable alternatives in specific vascular conditions for multimorbid patients, particularly when perioperative risk is a concern.
• Patient selection based on disease localization, stage, and life expectancy is paramount for optimizing outcomes with endovascular interventions.
• The adoption of endovascular approaches has broadened treatment accessibility and improved outcomes in certain vascular diseases, notably in elderly and frail populations.