Vascular

Vascular disease encompasses a wide range of disease processes. The common forms of vascular disease include aneurysmal or occlusive disease of arteries or veins in the neck, chest, abdomen and/or the extremities. Vascular pathology can be acute or chronic. In both acute and chronic cases, vascular disease can be limb or life threatening and both the disease and treatments can significantly impact a patient’s quality of life. Vascular patients frequently require complex case plans since they are typically elderly, frail and have multiple co-morbidities when compared to the general population. Patients undergoing procedures for vascular disease are at high risk for complications in the postoperative period, prolonged hospitalization and increase resource utilization.1 Since the tenets of enhanced recovery after surgery (ERAS) are to deliver high-quality perioperative care and accelerate recovery, reducing the need for healthcare resources and improving patient satisfaction, it is an ideal framework to improve the perioperative outcomes for a high-risk population like patients with vascular disease undergoing surgery.

Although ERAS protocols have gained significant popularity in specialties such as colorectal and orthopedic surgery, ERAS has not been widely accepted or adopted in vascular surgery. A review of current ERAS programs by McGinigle et al. demonstrated that the use of ERAS pathways in vascular surgery is limited and the evidence is at best moderate in aortic surgery and poor to absent other commonly performed procedures such as open and endovascular treatment of peripheral arterial disease.2 Although there is evidence to support advantages such as decreased length of stay for vascular surgery patients following implementation of ERAS, the authors acknowledged that further research is required to evaluate the effectiveness and appropriateness of ERAS in the vascular surgery population.

In 2022, the Enhanced Recovery After Surgery (ERAS) Society and Society for Vascular Surgery published a consensus statement on the use of enhanced recovery for patients undergoing open aortic vascular surgery. In this expert consensus review for implementation of ERAS after aortic surgery, there are 36 recommendations organized into preadmission, preoperative, intraoperative, and postoperative recommendations. Consensus recommendations for the implementation of ERAS after lower extremity arterial bypass are also forthcoming. We anticipate that these expert consensus documents will help support the acceptance and increase the application of ERAS following vascular surgery procedures. In the interim, it is our goal to advocate for the adoption of ERAS in vascular surgery and to provide vascular teams with the tools necessary for successful implementation.

References
1. Brooke BS , De Martino RR, Girotti M, Dimick JB, Goodney PP. Developing strategies for predicting and preventing readmissions in vascular surgery. J Vasc Surg. 2012 Aug;56(2):556-62.
2. McGinigle KL, Eldrup-Jorgensen J, McCall R, Freeman NL, Pascarella L, Farber MA, Marston WA, Crowner JR. A systematic review of enhanced recovery after surgery for vascular operations. J Vasc Surg. 2019 Aug;79(2): 629-640.