Risk factors and major vascular surgery

Abstract

The current interest in minimal invasive and, by inference, minimal risk general surgery has percolated to vascular surgery. Technological advance has resulted in the development of the angioscope, endoluminal ultrasound and devices which will 'rebore' atheromatous vessels by laser, drilling and radio-frequency thermal angioplasty: Endovascular surgery is born. 1 Unfortunately the restoration of patency to an occluded artery is not the sole indicator of success; until the problems of thrombosis and restenosis of arteries so treated is overcome conventional vascular reconstruction and its attendant risks will remain. Indeed, the vascular workload of many surgical departments is rising, coincidental with an increase in the incidence of aortic aneurysms. 2 Despite lack of advance in the basic methods of vascular surgery, (namely endarterectomy and replacement of a dilated or occluded artery with a prosthesis or autologous vein), the applications of vascular reconstruction have progressed. Aortic replacement in patients with asymptomatic aneurysms detected by community screening programmes, and femoro-distal bypass to achieve limb salvage in elderly patients are examples of time consuming and expensive procedures which can only be justified when accompanied by minimal morbidity and mortality.