Introduction Understanding the complex biology of coagulopathy and hemorrhage is critical to the perioperative management of surgical patients. “Coagulopathy” is a term employed loosely in the literature and in the clinical setting. Coagulation is a physiologic defense mechanism aimed at…
Introduction Vascular endothelial cells, blood, and extravascular tissue maintain blood flow fluidity or produce an integrated response to attenuate blood leakage by localized clotting at the site of vascular injury. The processes of blood coagulation and fibrinolysis are the primary…
Introduction Healthcare spending in the United States has increased dramatically over the past several decades. As of 2020, the US spends approximately $3.6 trillion annually on healthcare, or over 17% of the nation’s gross domestic product (GDP) ( Fig. 37.1…
Introduction Complex postoperative care in vascular patients is multi-dimensional and continues well beyond the patient’s hospital stay. Cardiac risk stratification preoperatively in the vascular surgical patient will help predict the level of intensity of monitoring required for the postoperative period…
It is well recognized that the intraoperative management of the patient is a significant determinant of the postoperative course and overall clinical outcome. In light of the frequent associated comorbidity, advanced age, lack of physiologic reserve, complexity of many therapeutic…
General Preoperative Risk Assessment Every patient undergoing elective vascular surgery should have a preoperative assessment that includes a thorough history and physical examination focused on cardiovascular risk factors, blood analysis, and electrocardiogram (ECG). A complete blood count should be obtained…
Background Vascular surgery has pioneered the development of various novel, minimally invasive catheter-based endovascular procedures within the confines of the open surgical operating room (OR). Portable image intensifier-based C-arm systems were the original imaging platforms on which catheter-based therapies have…
Introduction Catheter-based endovascular techniques are increasingly being used in vascular surgery, with demand for detailed intraoperative imaging increasing accordingly. Intravascular ultrasound (IVUS) is a catheter-based endoluminal guidance system that was initially utilized in interventional cardiology in the 1980s. Various trials…
Conventional radiological imaging modalities for the assessment of blood vessels have focused on size, irregularity of the vascular lumen, and anatomic changes in adjacent structures. The ability of these morphologic imaging techniques to identify physiologic changes such as active inflammatory…
Basic Principles Magnetic resonance imaging (MRI) is performed using a large external magnetic field, magnetic field gradients, and an applied oscillating magnetic field known as the radiofrequency field (RF). The combination of these three applied magnetic fields produces signals from…