Multimorbid vascular patients-do endovascular techniques expand the limits?

Abstract

The answer to the question of whether endovascular techniques extend the barriers to treatment in multimorbid vascular patients depends on the localization of the vascular disease and its stage. In multimorbid vascular patients with limited life expectancy and asymptomatic carotid stenosis, neither an endovascular nor an open procedure is indicated but aconservative best medicinal treatment is to be preferred. In symptomatic carotid stenosis the endovascular procedure is indicated for special anatomical conditions, such as contralateral carotid artery occlusion, contralateral recurrent nerve palsy, recurrent stenosis following endarterectomy, radical neck dissection and radiotherapy in the cervical region. In the treatment of intact abdominal aortic aneurysms (AAA), endovascular procedures reduce the perioperative risk especially in older patients, allowing the indications for intervention in this group of patients to be expanded, provided that the life expectancy of such treated patients is still several years. There is no clear evidence as to whether endovascular repair should be preferred in ruptured AAAs but there are indications that with the establishment of EVAR the proportion of patients receiving treatment has increased in those patients who were previously denied surgery after arrival in hospital. In critical limb ischemia the propagation of endovascular techniques has not so much extended the indications for invasive therapy but instead the endovascular approach has superseded open bypass surgery, which is positively reflected in alower perioperative morbidity, especially in older frail patients.