Anaesthesia for vascular surgery on the extremities

There are multiple types of procedure for vascular disease on the extremities, the majority of which are for the treatment of peripheral arterial disease (PAD). PAD is a common condition affecting 20% of people over the age of 60. Interventional treatment can be vascular, endovascular or combined (‘hybrid’) procedures by vascular surgeons and interventional radiologists.

PAD has risk factors in common with other atherosclerotic diseases which are often present, even if the patient is asymptomatic. Significant smoking histories are also common. Consequently, patients with PAD are a high-risk anaesthetic cohort. Comprehensive pre-operative assessment and investigation of the cardio-respiratory systems are essential to guide peri-operative planning. Multiple risk assessment tools are available to facilitate peri-operative decision making and risk-benefit discussions with patients.

The aim of intra-operative management is cardiovascular stability with proactive anticipation of events including haemorrhage and clamp release. Post-operatively regional anaesthesia is strongly advised particularly for patients undergoing amputation. Post-operative cardiac investigations may also be indicated.

Thoracic outlet syndrome and AV fistula formations are two specific clinical scenarios also covered in this topic.