Achievement of optimum health status

This is perhaps one of the most challenging aspects of pre-assessing vascular patients. It is, first of all, necessary to assess the risk factors a high percentage of these patients are, or have been, heavy smokers, diabetic, suffer from hypertension, raised cholesterol, ischaemic heart disease (IHD) and lead a sedentary lifestyle. Thus achieving optimum health status can be quite difficult. Health education and advice should be offered with the availability of a wide range of leaflets and...

Cigarette smoking and lung disease

A history of smoking is associated with more than a three times increase in post-operative lung problems. Even stopping smoking for a short period of time reduces this risk substantially. In the long term, smoking is a major risk factor for global lung diseases, such as asthma and chronic lung disease. Reduced lung function is associated with an increase in post-operative lung problems, and may necessitate post-operative ventilation. In severe lung disease, weaning the patient from mechanical...

Problems arising from surgery and anaesthesia Pain relief

Vascular surgery often requires large invasive procedures. Adequate pain relief is important not just on a humanitarian basis, but because it aids the patients recovery, physically and psychologically. If the patient's pain is under control from the moment they are awake, this is better than trying to treat established pain from inadequate analgesia. Poor post-operative pain relief can impair patient recovery and predispose to complications (e.g. chest infection following inability to cough)....

Renal failure

A degree of pre-existing renal failure is common in vascular patients even if this is not symptomatic. Poor urine output after surgery can be caused by a variety of problems. The kidneys are also sensitive to periods of hypoxia and hypotension. If there is a low urine output (Table 5.5.8) following surgery, the following strategy is adopted 1. If the patient is not catheterised, ask about the urge to pass urine, and check if the bladder is distended and palpable. Catheterisation may be required...

Conventional Angiography

Patients arrive at this stage when it is felt that something must be done either for intractable limiting claudication or critical ischaemia with rest pain and or the prospect of amputation. The aim is to avert surgery either for amputation or surgical bypass, or to aid planning for surgery. In some centres many radiological interventional procedures are performed as day cases (Macdonald et al., 2002), which requires a suitable infrastructure, but in other places much of the work involves...

Patients who are at risk of sudden deterioration

Deterioration can be anticipated (due to the nature of a pre-existing condition or the type of surgery undergone) or unanticipated. It is important to remember that unanticipated deteriorations can be due to equipment failure, or idiosyncratic reactions to therapy (e.g. drug allergy) as well as unexpected conditions, such as heart attack, or pulmonary embolus. Proper attention to basic patient care and monitoring can prevent or allow early detection of some of these conditions. Patients are...

Diabetic ulcers

Due to the complex aetiology of diabetic ulcers, a thorough evaluation is crucial before any treatment is instituted. This evaluation should determine whether the ulcer is neuropathic, neuro-ischaemic or ischaemic. An adequate description of the ulcer in terms of size, depth, appearance and location is also important, as it will help monitor the progress of treatment. If there is evidence of infection a swab should be taken for culture and sensitivity and appropriate antibiotics should be...

Varicose Veins

Surgery for varicose veins, involving long or short saphenous system in the lower limb, is considered when they are symptomatic or present with complications. The assessment of patients should be done clinically to determine the incompetence in the superficial system and to rule out incompetence of deep venous system. This may be followed by investigations, like venous Duplex studies or venography, for the deep system. When the decision for surgery is made then the patient is assessed regarding...

List Of Abbreviations

American Society of Anaesthesiologists Alert, verbal, painful, unresponsive Chronic obstructive pulmonary disease Department of Health and Social Security Endo-vascular aortic aneurysm repair Invasive positive pressure ventilation Multi-centre aneurysm screening study Matrix metalloproteinase proteinases Non-invasive positive pressure ventilation

Managing Lymphoedema A Clinic Approach

Lymphoedema is a progressive chronic swelling of the limbs and the body that occurs as a result of an inadequate compromised lymphatic system. The most common form is in a limb, but it can affect any part of the body. At present there are no accurate figures of the number of people with lymph-oedema, although it has been estimated that 144 per 100,000 are affected. (Casley-Smith, 1997). Predominantly in the literature breast cancer related swelling is the most quoted, and this equates to an...