Major vascular surgery

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What are some examples of major vascular surgery?

• Endovascular aneurysm repair (EVAR): stents passed through an artery (usually femoral) and guided to the aorta via fluoroscopy without operating directly on the aorta.

• Open aortic surgery: direct repair of the aorta via abdominal or retroperitoneal incision.

• Carotid endarterectomy: removing an atherosclerotic plaque in the carotid artery to correct stenosis and reduce risk of stroke.

• Vascular bypass: procedure that redirects blood flow by reconnecting blood vessels to bypass a diseased artery (e.g., fem-fem, fem-tib, aortoiliac).

• Arteriovenous fistula creation: surgical connection between artery and vein to provide vascular access for hemodialysis.

• Vein stripping: surgical removal of varicose veins.

• Angioplasty: endovascular procedure to widen stenosed arteries and veins.

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Define aortoiliac occlusive disease.

Aortoiliac occlusive disease is a type of peripheral arterial disease (PAD) that is characterized by atherosclerotic changes within the aorta (usually abdominal) that extend into the iliac and femoral arteries, which results in hypoperfusion of vital organs and the lower extremities. Involvement at the iliac bifurcation and renal arteries is common; aneurysmal changes may be found as well.

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Define abdominal aortic aneurysm.

An abdominal aortic aneurysm (AAA) is a focal dilation that is 1.5 times the artery’s normal diameter and is a relatively common cause of sudden death in the elderly (approximately 5% of sudden deaths). A normal aortic diameter is approximately 2.0 cm; therefore an AAA is 1.5 times this diameter or 3 cm. The majority of AAAs are asymptomatic, but some patients may present with abdominal pain and other complications (e.g., thrombus). Approximately 50% of patients with a ruptured AAA reach the hospital alive and half of those patients do not survive. Aneurysm size is the greatest predictor of potential rupture and the risk of rupture increases substantially with diameters greater than 5.5 cm. Elderly male patients (i.e., 65–75 years) that have a significant smoking history should be screened for AAA by ultrasound. An AAA found to be greater than 5.5 cm in diameter or increasing at a rate greater than 0.5 cm in diameter over the past 6 months, regardless of size, warrant surgical repair.

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What risk factors and coexisting diseases are common in patients with aortoiliac occlusive disease or AAA?

Risk factors include smoking, family history, obesity, atherosclerotic disease elsewhere, advanced age, and male gender. Common diseases include hypertension, ischemic heart disease, heart failure, chronic obstructive pulmonary disease (COPD), diabetes mellitus, chronic kidney disease, and carotid artery disease. Patients with AAA have a similar risk profile but smoking appears to be the strongest risk factor above all else.

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