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Part 4. Managing Anesthesia Care
Section E. Specialty Areas of Anesthetic Practice
Chapter 54. Anesthesia for Major Vascular Surgery
Alina Nicoara, MD, and Madhav Swaminathan, MD
1. Atherosclerosis is a multifactorial disease. Besides traditional risk factors (age, sex, elevated blood pressure, smoking, high levels of low-density lipoprotein [LDL] cholesterol, and low levels of high-density lipoprotein [HDL] cholesterol), newer risk factors have been described, such as fasting glucose, triglycerides and triglyceride-rich lipoprotein remnants, lipoprotein (a), homocysteine, and high-sensitivity C-reactive protein.
2. The precise mechanism of final injury caused by atherosclerosis is one or more of the following: (a) plaque enlargement reducing blood flow; (b) arterial embolism of plaque-associated platelet thrombi or atheromatous debris; and (c) complete occlusion of arteries at sites of advanced plaques.
3. Patients presenting for major vascular surgery usually have either overt or occult involvement of several organ systems. The vascular patient population has a high incidence of significant coronary artery disease (CAD); for example, left ventricular systolic dysfunction (left ventricular ejection fraction less than 40 percent) is five times more common in patients with cerebrovascular disease or peripheral arterial disease compared with matched controls.
4. The current standards for preoperative cardiac evaluation of these patients are the guidelines published by the American College of Cardiology (ACC) and the American Heart Association (AHA),..."
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