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Evaluation of the vascular surgical patient 

Evaluation of the vascular surgical patient
Chapter:
Evaluation of the vascular surgical patient
Author(s):

Dr Jonathan P. Thompson

, Dr Simon J. Howell

, and Dr Richard J. Telford

DOI:
10.1093/med/9780199594429.003.0003
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date: 21 October 2019

The vascular surgery patient frequently has cardiovascular disease affecting several organ systems. This may be compounded by respiratory insufficiency and diabetes mellitus. These co-morbidies can significantly increase the risk associated with major surgery. Patients presenting for elective vascular surgery should be seen and assessed by an experienced vascular anaesthetist before operatioon. Ideally this should take place in a dedicated preassessment clinic with access to appropriate investigations and support from other medical specialities. A number of scoring systems have been proposed for the estimation of perioperative risk. Dynamic testing may provide additional information to inform risk assessment. Cardiopulmonary exercise testing and dobutamine stress echocardiography are amongst the tests used for this purpose. The results of preoperative risk assessment should be discussed a multidisciplinary team meeting with input from anaesthetists, surgeons and radiologists as a minimum. The perioperative risk assessment may inform the choice of operation, or indeed lead to a decision not to operate. Input from colleagues in other disciplines, notably cardiology, is often invaluable. Preoperative inventions such as the modification of drug treatment may reduce perioperative risk. Whilst prophylactic coronary revascularization does not yield benefit, some vascular surgery patients have a primary indication for such intervention. Planned perioperative care may include admission to intensive or high dependency care as well as chest physiotherapy and incentive spirometry. Finally, careful conversation with the patient to elicit his or her preferences is essential.

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