Anesthesia Management in Surgical Treatment of Peripheral Arterial Disease
Özet
This document comprehensive reviews anesthesia management in the surgical treatment of peripheral arterial disease (PAD), a systemic atherosclerotic condition associated with high mortality and morbidity. Classic predisposing risk factors for PAD include smoking, diabetes mellitus, advanced age, hypertension, hypercholesterolemia, male gender, hyperhomocysteinemia, and genetic predisposition. Preoperative evaluation requires a detailed cardiovascular assessment, diagnostic tests, and the strategic discontinuation of antihemostatic drugs based on specific pharmacological intervals. During the intraoperative period, the choice of anesthesia method varies according to the specific vascular surgical procedure being performed. For axilla-femoral/bifemoral bypass, anesthesia can range from general to local or tumescent options combined with sedoanalgesia under hemodynamic monitoring. Lower extremity revascularizations frequently utilize regional anesthesia due to its benefits in suppressing surgical stress responses and optimizing post-operative analgesia. In emergency procedures such as embolectomies, local anesthesia remains the preferred approach. Given that cardiac complications represent the most significant cause of perioperative morbidity, managing these high-risk patients successfully requires close postoperative hemodynamic monitoring, rigorous pain control, and ongoing monitoring of cardiac biomarkers.
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