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Management of patients undergoing specific elective vascular procedures 

Management of patients undergoing specific elective vascular procedures
Chapter:
Management of patients undergoing specific elective vascular procedures
Author(s):

Dr Jonathan P. Thompson

, Dr Simon J. Howell

, and Dr Richard J. Telford

DOI:
10.1093/med/9780199594429.003.0009
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date: 18 October 2019

This section describes all aspects of perioperative care for patients undergoing elective vascular surgical procedures, in a comprehensive yet succinct manner. It is intended as a ‘How to do it’ guide for the trainee or more experienced vascular anaesthetist to inform their everyday practice. Each section is prefaced by a brief clear summary of the procedure in question. In each section, the relevant pathophysiology is described in turn and each surgical procedure is outlined along with the clinical features, preoperative considerations, therapeutic options, and all aspects of perioperative care. Special features in this chapter include a description of specific problems and key steps in anaesthetic management for different procedures. Treatment guidelines and algorithms are included to aid decision making. The sections on aortic surgery include elective open infrarenal, juxtarenal and thoracoabdominal aneurysm repair repair, endovascular aneurysm repair and hybrid procedures, and procedures for aorto-iliac occlusive disease. These all contain full descriptions of anaesthetic techniques and special requirements including spinal cord protection. The section on carotid disease covers carotid endarterectomy, carotid artery stenting, carotid body disease, procedures for subclavian steal and combined carotid artery -coronary artery surgery. Complications specific to carotid surgery (management of postoperative hypertension, neck haematoma and cerebral hyperperfusion syndrome) are detailed independently for clarity. Descriptions of lower limb bypass surgery, endoscopic thoracic sympathectomy, thoracic outlet syndrome, renal fistula formation, long term vascular access procedures, lower limb amputation and uncommon procedures such as retroperitoneal sarcoma surgery are also included. The authors feel that this chapter incorporates all the information needed by the vascular anaesthetist to provide excellent perioperative care across the full range of vascular surgical procedures.

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