TY - CHAP M1 - Book, Section TI - Arterial Disease A1 - Lin, Peter H. A1 - Poi, Mun Jye A1 - Matos, Jesus A1 - Kougias, Panagiotis A1 - Bechara, Carlos A1 - Chen, Changyi A2 - Brunicardi, F. Charles A2 - Andersen, Dana K. A2 - Billiar, Timothy R. A2 - Dunn, David L. A2 - Hunter, John G. A2 - Matthews, Jeffrey B. A2 - Pollock, Raphael E. PY - 2015 T2 - Schwartz's Principles of Surgery, 10e AB - Carotid intervention as a preventive strategy should be performed in patients with 50% or greater symptomatic internal carotid artery stenosis and those with 80% or greater asymptomatic internal carotid artery stenosis. Carotid intervention for asymptomatic stenosis between 60% and 79% remains controversial and is a function of an operator’s stroke rate. The choice of intervention—carotid endarterectomy versus carotid stenting—remains controversial; currently, carotid endarterectomy appears to be associated with lower stroke rate, whereas carotid stenting is more suitable under certain anatomic or physiologic conditions.Abdominal aortic aneurysms should be repaired when the risk of rupture, determined mainly by aneurysm size, exceeds the risk of death due to perioperative complications or concurrent illness. Endovascular repair is associated with less perioperative morbidity and mortality compared to open reconstruction and is preferred for high-risk patients who meet specific anatomic criteria.Symptomatic mesenteric ischemia should be treated to improve quality of life and prevent bowel infarction. Operative treatment—bypass—is superior to endovascular intervention, although changes in wire and stent technology have improved the results of mesenteric stenting in recent series.Aortoiliac occlusive disease can be treated with either endovascular means or open reconstruction, depending on patient risk stratification, occlusion characteristics, and symptomatology.Claudication is a marker of extensive atherosclerosis and is mainly managed with risk factor modification and pharmacotherapy. Only 5% of patients with claudication will need intervention because of disabling extremity pain. The 5-year mortality of a patient with claudication approaches 30%. Patients with rest pain or tissue loss need expeditious evaluation and vascular reconstruction to ameliorate the severe extremity pain and prevent limb loss. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1117746919 ER -