By some estimates over 100 million people in the USA will be experiencing vascular disease that requires significant medical management and/or procedural treatment in the next 10-15 years. As vascular disease develops over the lifespan of each individual, it is a perfect candidate for a multi- specialty, population health approach. Such a model would bring together the primary and specialty care medical communities to optimize vascular disease prevention, diagnosis, appropriate referral and transition, and a broad spectrum of medical and surgical treatment when indicated and necessary to preserve limbs, lives, and restore quality of life. This is a broad, bold, and compelling vision, that is being explored by the SVS Task Force on Population Health.
This Practice Management Guide was designed to focus on a segment of this broader vascular population health model: When vascular disease progresses to a stage where procedural treatment is necessary and indicated. It was developed by a multi-disciplinary team as an easy-reference resource to highlight and integrate key information and suggested best practices to address 10 of the most common vascular disorders faced by medical teams. Outcome research for vascular patients requiring procedural intervention strongly suggests that optimizing the medical management of patients with vascular disease in the perioperative horizon—30-90 days before intervention, during the intervention, and 30-90 days post- intervention, may have a profound impact on long-term health, and quality of life. Due to the complexity of the medical and surgical management that is often required in common vascular conditions, the perioperative period is an inherently risky time in a patient’s life. Vascular conditions requiring surgical/endovascular intervention often develop due to poorly- or uncontrolled medical co-morbidities, and meticulous attention to all facets of peri-operative care from the entire care team can mean the difference between a successful recovery and a life- threatening complication. The bottom line is that optimizing care of patients throughout this perioperative horizon requires a full team effort, crossing many professions and medical specialties. Working in a coordinated fashion has been proven to reduce care variation, and thereby can improve and hasten the surgical recovery process for patients. An excellent reference and body of literature for further exploration of team-based perioperative care can be found in the Enhanced Recovery After Surgery (ERAS®) model, a multimodal, multidisciplinary approach to the care of surgical patients that aims to reduce the stress of the operation to retain anabolic homeostasis. The importance of patient education and patient engagement in their vascular perioperative care is a key component of both ERAS® Guidelines and the practice suggestions put forth in this Practice Management Guide.161-164
Vascular surgeons have a clear and essential role in the population health of our patients. As we often experience the end-result of progressive vascular disease process, no medical or surgical specialty has a stronger stake and understanding of the importance of vascular disease prevention, diagnosis and early treatment, and ensuring access to quality vascular care for all of our elderly citizens.
When vascular disease does progress to requiring procedural or surgical intervention, we hope you will find this resource helpful in planning for the entire perioperative horizon of care, and integrating the perspectives of vascular surgeons, anesthesiologists, vascular medicine, vascular nursing, and vascular physician assistants.
This Guide is a beginning, and we hope it encourages many similar future efforts in the SVS and across Societies, to bring professions and disciplines together to optimize care for our vascular patients, for whom we care deeply.