Vascular Surgeries

The most common vascular surgeries are those done on the carotid artery and the abdominal aorta, and I got to provide anesthesia for these surgeries on my first day on cardiac. In the same way that cholesterol can build up in coronary arteries for the heart, plaques develop in the arteries of the neck supplying the brain and in the aorta. The image above shows one of these carotid plaques at the bifurcation of the vessels going up to the head. As you can imagine, these can easily cause a stroke.

The anesthesia for these procedures can be delicate. Patients who have plaques like this are likely to have them on the heart; they are unfortunately the smokers with high blood pressure, poor cholesterol, diabetes, and obesity. So these procedures have a higher-than-normal risk of heart attack and stroke. We have to use a gentle induction of anesthesia to maintain a good blood pressure through the surgery (some people even do these surgeries awake with local anesthetics, but this is a lot less common these days). We use fancy monitoring of the brain that can detect gross changes in cerebral oxygenation; this can clue us in on a stroke early on.

The same thing applies to those with disease of the abdominal aorta. Aneurysms of the aorta develop in areas of wall weakness from cardiovascular disease. Some of these patients are too sick to have the aneurysms repaired in an open fashion, but now we can fix them intravascularly with stents deployed from the groin. However, as I provide anesthesia for these patients, I am reminded that we have to be aware of all the organs; the lungs of these smokers are often poor, their obesity makes the airway challenging, they have presumed heart disease and often have poor exercise tolerance. Although these procedures are common, we cannot be cavalier with them.

Image of carotid artery plaque shown under Creative Commons Attribution License, from Wikipedia.