Vascular Surgery in the Elderly

Evidence-based medicine has demonstrated that the geriatric population is at risk for poor surgical outcomes due to the prevalence of chronic diseases such as hypertension, hyperlipidemia, diabetes, coronary artery disease, and chronic lung and kidney disease. These long-standing chronic medical conditions, together with years of exposure to environmental stressors, poor diet, nicotine, alcohol, polypharmacy etc., are strong risk factors for developing vascular pathologies requiring medical and surgical intervention. The incidence of arterial diseases increases with age. Vascular surgery as a branch of surgery deals with treating and attending to this unique age group of the population. It is important for the treating physician to understand the concepts of physiological changes in the vasculature in the elderly, the different disease processes that arise as a result of them, and the various modalities available for their management. The decision to perform a vascular procedure in the elderly does not depend on knowing merely what surgeries to perform. Understanding the patient’s social background, anticipated quality of life after intervention, and presence or absence of family support forms the other half of the toolkit required to provide not only the best available treatment for the disease but the best-suited management for that patient. This patient-centered approach with the patient participating in the overall management plan is the new paradigm. This chapter acknowledges the scope of this unique issue and analyzes various vascular diseases in the elderly with special focus on the current trends in diagnosis and treatment.