Intraoperative management: peripheral vascular surgery

Lower extremity atherosclerotic disease affects nearly 10 million people in the United States [1]. Recent advances in atherosclerosis include an understanding of the pathophysiologic role of inflammation in atherosclerosis and its progression [2], and the addition of magnetic resonance angiography (MRA) as a powerful diagnostic tool that has reduced the necessity for contrast angiography and its attendant risks. Medical and interventional radiologic techniques also help many patients to avoid more invasive surgical procedures. Subsequently, the vascular surgery patients who now enter the operating room for peripheral vascular surgery represent the subset whose lesions are refractory to medical management, not amenable to endovascular techniques, or who have significant comorbidities.