[Carotid and aortic lesions: two-stage surgery]

Area of Science:

• Vascular Surgery
• Surgical Risk Management
• Chronological Surgical Planning

Context:

• Patients with concurrent carotid artery and lower extremity arterial diseases (aorto-iliac or femoropopliteal) present complex treatment challenges.
• Simultaneous surgical intervention for these conditions increases overall patient risk and complicates surgical practice.
• Determining the optimal timing and sequence of surgical interventions is critical for patient outcomes.

Purpose:

• To evaluate the safety and efficacy of sequential versus simultaneous surgical approaches for patients with combined carotid and lower extremity arterial disease.
• To determine if sequential surgery impacts the progression of untreated vascular disease.
• To provide evidence-based recommendations for surgical planning in complex vascular cases.

Summary:

• Sequential surgical intervention is identified as a safer alternative to combined procedures for patients with both carotid and aorto-iliac or femoropopliteal diseases.
• Performing surgeries sequentially does not elevate the risk of adverse events in the vascular territories not yet operated upon.
• This approach mitigates the increased surgical risks associated with simultaneous operations.

Impact:

• Establishes sequential surgery as a preferred, safer strategy for managing multi-level atherosclerotic disease.
• Offers guidance to surgeons on optimizing procedural order to minimize patient risk and improve safety.
• Potentially reduces postoperative complications and improves long-term outcomes for patients with complex vascular conditions.