[Peripheral vascular surgery in the high-risk patient]

Area of Science:

• Vascular Surgery
• Anesthesiology
• Cardiovascular Interventions

Context:

• High-risk patients in peripheral vascular surgery often present complex local (morphological, hemodynamic) challenges, particularly during prolonged procedures.
• The selection of low-risk, partial, or palliative operations, including extra-anatomical bypasses, is crucial for managing these complex cases.
• Appropriate anesthesiological strategies are essential for optimizing outcomes in high-risk vascular surgery patients.

Purpose:

• To review various peripheral arterial reconstruction techniques and present experience with specific procedures.
• To evaluate the distribution and outcomes of extra-anatomical procedures in high-risk versus local/angiological-morphological patient groups.
• To discuss the suitability of different anesthesia methods for various peripheral vascular interventions.

Summary:

• The study reviewed experience with 37 axillo(bi)femoral bypasses, 54 cross-over bypasses, 41 iliac TEA's, 30 dilatations, 580 embolectomies, 257 deep femoral artery reconstructions, and 19 in situ vein bypasses.
• Extra-anatomical procedures demonstrated a significant difference in one-year survival: 50% for high-risk patients versus 85% for local/angiological-morphological cases.
• Local anesthesia is suitable for embolectomies; spinal, peridural, or combined regional/general anesthesia are preferred for other indications, emphasizing the need for skilled anesthesiologists.

Impact:

• Highlights the importance of tailored surgical and anesthesiological approaches for high-risk patients in peripheral vascular surgery.
• Demonstrates the improved survival associated with extra-anatomical procedures in specific patient subgroups.
• Provides evidence-based recommendations for anesthesia selection in diverse peripheral arterial reconstruction scenarios.