[Peripheral vascular surgery in the high-risk patient]

In peripheral vascular surgery a patient not infrequently becomes a high-risk case on account of local causes (morphological, haemodynamic), especially during long operations. Hence, low-risk procedures like partial or palliative operations, including extraanatomical procedures, and appropriate anaesthesiological methods are very important. This report includes several possibilities of peripheral arterial reconstruction, as well as a review of experience gained in 37 axillo(bi)femoral and 54 cross-over bypasses, 41 closed retrograde TEA's of the iliac region, 30 transluminal dilatations, 580 embolectomies, 257 reconstructions of the deep femoral artery and 19 in situ vein bypasses (Hall). The distribution of extraanatomical procedures in a high-risk and a local or angiological-morphological situation showed that after one year only 50% of high-risk patients were still alive compared with 85% of the latter group. Local anaesthesia was very suitable for embolectomies, whilst for other indications we prefer spinal and peridural or combined regional and general anaesthesia, with the proviso that the patient is in the hands of a skilled anaesthesiologist.