Care of the Vascular Surgical Patient

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Atherosclerosis is a systemic disease that affects multiple arterial beds throughout the body. Peripheral arterial disease (PAD) is a condition in which progressive atherosclerotic disease leads to stenosis and occlusion in vessels of the upper and lower extremities.1,2 Other aortic branch vessels that may be affected include the mesenteric and renal arteries as well as the carotid arteries.1,3,4 It is estimated that PAD affects 8 to 12 million people in the United States. It is age-related and is now equal among men and women, with as many as 202 million people affected worldwide.1,2 Acute mesenteric ischemia is estimated to be responsible for acute abdomen in 10% of people over the age of 70. The incidence of chronic mesenteric ischemia is unknown.3 Carotid stenosis prevalence increases with age and is more common in men than women.4 The consequences of atherosclerotic disease include a decrease in quality of life with reduction in everyday activities and a greater risk of cardiovascular morbidity and mortality regardless of the arterial bed affected.2 Treatment is aimed at prevention or reduction of long-term complications.

Venous insufficiency is estimated to affect as many as 2.5 million people in the United States and is a chronic debilitating disease.5 Up to 20% of those with venous insufficiency go on to develop lower extremity ulcers. The treatment of venous disease is aimed at preventing long-term complications such as chronic edema and ulceration.


Aneurysm A localized abnormal dilation, distention, or sac in an artery. True aneurysm involves all arterial layers. Dissecting aneurysm allows blood to dissect between the vessel layers. False aneurysm (pseudoaneurysm) develops as a result of disruption of the vessel wall that allows blood to escape from the lumen into a contained sac.5

Angiography (Arteriography) The injection of radiopaque dye into the arteries followed by rapid sequential radiographs of the vascular tree for determination of abnormalities in a specific region.5,6

Atherectomy Procedure performed with a special catheter that contains a shaver device at the distal tip. The rotating blade shaves the plaque from the inner lining and removes it from the vessel through a suction device.5

Bypass Performed to reroute blood flow around an area of stenosis in a blood vessel.5

Cryoplasty A technique that uses cooling and balloon angioplasty to open stenotic vessels.7

Embolectomy Extraction of an embolus from an artery to restore blood flow.5

Embolus Fragment of thrombus that moves to another area in the vessel; may also be atheromatous plaque or tumor particles.5

Endarterectomy Surgical removal of atheromatous plaque from a stenotic vessel.5

Endograft Device designed to exclude an area of a blood vessel and provide a new conduit through which blood flows. It is primarily used to exclude aneurysmal vessels.5

Fibrinolytic (Thrombolytic) Therapy Technique that uses clot-dissolving agents to dissolve clot material in a blood vessel.5

Ischemia Lack of adequate blood flow to an area to meet the needs of the tissues.5

Ligation Transection and tying off of a blood vessel.5

Stent Device made of metal or other material used to maintain patency of a blood vessel after angioplasty. The device may be balloon expandable or self-expanding.5,7

Sympathectomy Interruption of the sympathetic nerve chain performed to produce vasodilation of blood vessels distal to the surgical site.5

Thrombectomy Surgical removal of a thrombus.5

Thrombus Stationary blood clot or atheromatous plaque that partially or totally occludes a blood vessel.5

Transluminal Angioplasty Use of a special catheter with a balloon at the distal tip passed through the vessel to the area of stenosis and inflated to compress stenosis and widen the vessel lumen. The balloon is deflated before removal of the catheter from the vessel. The procedure may be done percutaneously with only a puncture site, or open through an incision in the vessel, and it may be done in conjunction with a stent, atherectomy, or cryoplasty.5,7

General considerations

Patients with atherosclerotic disease commonly have other underlying disease processes, some of which may contribute to the development of disease and increase the morbidity and mortality rates associated with surgery. Among the underlying conditions are chronic tobacco use with chronic obstructive pulmonary disease, diabetes, peripheral neuropathy, hypertension, dyslipidemia, obesity, and advancing age.2,5

The progression of atherosclerosis, which leads to most vascular surgical procedures, is a systemic disease that affects all arterial beds including those in the extremities, heart, kidneys, and brain.24 A vital part of treatment of arterial disease is risk factor modification to include smoking cessation and control of underlying comorbidities such as diabetes, hypertension, and dyslipidemia.2,5 Venous surgical procedures have also increased in number as a result of improvements in technology and the use of minimally invasive techniques.5,8 This chapter is limited to care of the patient undergoing surgery on blood vessels outside the heart.

Diagnostic procedures

Noninvasive diagnostics, such as the ankle brachial index (ABI), ultrasonography, computed tomography angiogram (CTA), and magnetic resonance angiography (MRA) and imaging (MRI), have contributed greatly to the early treatment of vascular disease.5 These procedures do not usually require sedation.

The ABI is a ratio of ankle-to-brachial blood pressure. PAD is present if the ABI is 0.90 or less.2,5Box 36.1 describes the calculation of an ABI. This test may also be used postoperatively to assess the patency of vessels following stent placement, percutaneous transluminal angioplasty (PTA), bypass graft placement, or endarterectomy. In patients with diabetes who have developed calcification of the large vessels, an ABI might not be obtainable because of the inability to fully compress the vessels to obtain a pressure. In these patients, toe-brachial index is a useful tool for assessing distal blood flow.1,5

Arteriography continues to be the gold standard for invasive diagnostic testing and usually requires intravenous (IV) sedation. This test requires direct injection of contrast media into the arterial bed and is used to examine the arterial supply of a specific region. Arteriography can also be done in conjunction with various treatment methods including angioplasty, cryoplasty, atherectomy, and stenting.5,7,9

Endovascular procedures

Endovascular treatments for PAD include PTA, PTA with stent placement, atherectomy, cryoplasty, and fibrinolytic therapy.5,7 These procedures are performed by a variety of specialists including interventional radiologists, vascular surgeons, and cardiologists. These procedures may require only local anesthetic and IV sedation depending on the patient’s condition and physician’s preferences. The procedures can also be performed alone or in conjunction with other vascular surgical procedures in the operating room and may be done with local plus IV sedation, epidural, spinal, or general anesthesia.5,10

PTA may be performed on carotid, aortic, mesenteric, renal, iliac, femoral, popliteal, and tibial vessel stenosis. This procedure may be used alone or in conjunction with stent placement. Major complications after PTA or stenting include bleeding, hematoma, thrombus formation or embolism, and intimal tears (disruption of the inner lining of the vessel) or perforation.5,7 Other complications may occur specific to the vascular bed being treated such as transient ischemic attack or stroke for carotid stenting and worsening renal failure in treatment of renal artery stenosis.5 Stents are used to compress and hold the plaque against the vessel wall. Covered stents have been shown to have higher patency rates than bare metal stents.5,7 They can also be used to treat an intimal tear in the vessel wall. Stents and balloons with drug coating such as paclitaxel may be used for some lesions and appear to reduce in-stent stenosis as a result of their effects on smooth muscle cell proliferation. They have primarily shown promise in locations where in-stent restenosis is high and are believed to improve long-term patency rates. There are conflicting studies in regard to possible increase in mortality associated with paclitaxel. Further research is needed to determine a definitive relationship in use of paclitaxel and mortality.7

Atherectomy is a technique designed for removing plaque from the vessel wall with a special rotating blade and suction apparatus. Atherectomy devices may be directional, rotational, or laser. Angioplasty or stenting may follow atherectomy.7 Cryoplasty balloons were previously used to combine freezing and dilation of arteries with the belief that they would reduce vessel dissection and intimal hyperplasia. They have not proven to be very effective and are rarely used.7

After these procedures, patients are monitored for recovery from IV sedation and for bleeding and hematoma formation at the puncture site.5 Distal pulses are assessed bilaterally to detect any change in blood flow that may be related to formation of an embolism or thrombus for procedures that involve the abdominal vessels or extremities.5 These pulses should be compared with the baseline pulses documented before the procedure. Intake and output should be monitored closely, and adequate hydration should be maintained after any procedure with IV contrast. IV contrast can be toxic to the renal system, leading to contrast-induced nephropathy (CIN); this is characterized by an increase in creatinine of 25% from baseline within 48 hours of contrast administration.11 This is of greater concern in patients with preexisting diabetic nephropathy, glomerular filtration rate (GFR) < 60, older age, heart failure, extremes of body mass index (BMI > 30 or < 18), anemia, high contrast dose, and hypertension. Treatments such as additional IV fluids, N-acetylcysteine, and sodium bicarbonate can be used to provide additional protection against CIN. Other treatments may include holding medications such as metformin prior to any study using contrast. Some newer studies indicate that continuing metformin for 48 hours prior to contrast administration may not increase the risk of CIN.10,11

Bed rest is maintained for 6 to 8 hours after the procedure with the extremity in a straight position to prevent bleeding at the puncture site. If a closure device is used at the puncture site, the patient may be allowed out of bed sooner.5,12 Any patient who undergoes an arteriogram, angioplasty, or stenting that involves the carotid or cranial circulation should undergo frequent neurologic assessment after the procedure. Special protection devices are used during carotid angioplasty and stenting to trap any free-floating particles of plaque or thrombus that may be dislodged during the procedure. These devices serve to minimize postprocedural complications such as stroke.3,13

Fibrinolytic therapy is used when an embolus or thrombus has occluded a vessel. Special catheters are placed in the area of the thrombus, and agents such as alteplase, tenecteplase, or reteplase are used to lyse the clot.5 This process can be done by initial bolus and then completed via infusion and may take hours for complete lysis of the thrombus. These patients need close observation throughout the infusion for signs of bleeding, bruising, anaphylaxis, hematoma at the puncture site, and hematuria. Blood pressure should be monitored closely to decrease the risk of cerebral hemorrhage. Assessing for signs of cerebral bleeding is critical. If treatment is needed for bleeding, aminocaproic acid (Amicar) can be used to inhibit the fibrinolytic process.6 Frequent assessment of the limb is also needed as reperfusion occurs. As the limb reperfuses, pain may actually worsen initially as microemboli break away from the thrombus and move distally to smaller vessels. As the infusion continues, pain improves as these emboli are dissolved. Frequent laboratory work includes serial monitoring of complete blood count, fibrinogen, prothrombin time and international normalized ratio (PT/INR), and partial thromboplastin time (PTT).14 Periodic assessment in radiology is done to follow the progress of the lytic agent. The infusion is discontinued when lysis is complete, bleeding occurs that necessitates transfusion, or no response to the agent is found.5,14 Studies completed in the past 5 years that examined monitoring of fibrinogen suggest that it may not be a significant indicator for bleeding risk, but most recommendations support the need to keep the level above 100.15

Medications used in vascular surgery

Anticoagulants are among the most commonly used medications in the treatment of the patient for vascular surgery. Unfractionated heparin can be administered before, during, and after surgery. Its actions occur at multiple points in the coagulation cascade to ultimately inactivate thrombin and prevent conversion of fibrinogen to fibrin. Heparin has a short 60- to 90-minute half-life and may be administered IV or subcutaneously. The response to heparin is measured with the activated PTT and is targeted at 1.5- to 2.5-fold greater than normal to obtain a therapeutic response and prevent thromboembolism. Therapeutic levels can only be obtained by continuous IV infusion.16 Complications associated with the use of heparin include increased risk of bleeding and heparin-induced thrombocytopenia (HIT). Platelet counts should be monitored for decrease of 40% to 50% from baseline or any decrease to less than 100,000. If HIT develops, heparin must be discontinued, and alternative anticoagulants should be used.16 Protamine is the antidote for heparin; its action occurs within 5 minutes of administration. Care must be taken to avoid overly rapid administration of protamine. When administration is too rapid, side effects can include hypotension, pulmonary hypertension, shortness of breath, and flushing. The usual target dose for reversal is 1 mg of protamine for every 90 units of heparin.16

Low-molecular-weight heparins (LMWHs), such as enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep), may also be used in the care of the patient for vascular surgery. These drugs are administered subcutaneously and have a significantly lower molecular weight than unfractionated heparin, which gives them improved predictability in the dose response and a longer half-life. This advantage greatly reduces the need for laboratory monitoring. If testing is needed, antifactor Xa level is the test of choice for monitoring. The LMWHs are administered subcutaneously and have a significantly lower incidence rate of HIT associated with their use; they are primarily used to prevent thromboembolism after surgery but are also approved in the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE). They may also be used to bridge patients before and after surgery who require long-term anticoagulation with warfarin (Coumadin) or other anticoagulants. The decision to bridge (use a short-acting blood thinner) is based on diagnosis and thromboembolic risk. Patients with renal disease may need a dose reduction depending on the severity of their disease. Complications are similar to those of unfractionated heparin. Laboratory testing should be monitored for signs of HIT, although it occurs much less frequently with the use of LMWH.5,16 The decision to bridge a patient in the perioperative period is based on the risk of thrombosis and the risk of bleeding.17 Patients with a low risk of bleeding and thrombosis are usually safe not being bridged. Patients with high risk of thrombosis and bleeding are generally bridged, and the anticoagulant is held periprocedure.17 If there is a low risk of thrombosis with a high bleeding risk surgery or procedure, the recommendation is to hold the anticoagulant without bridging. For patients with a high risk of thrombosis but a low risk of bleeding or low risk of thrombosis and bleeding, anticoagulants may be continued during the procedure.17

Warfarin is an oral anticoagulant that inhibits vitamin K–dependent coagulation factors and the anticoagulant proteins C and S; it has a half-life of 36 to 42 hours. Monitoring of warfarin is done with PT/INR.16 The PT/INR is laboratory dependent, and specific methods vary among institutions. Caregivers should be familiar with institutional methods. For long-term monitoring, the INR alone is used. Warfarin is used to treat a variety of thromboembolic disorders, and it can be used to promote long-term patency of infrainguinal bypass grafts after thrombosis of previously placed grafts. Complications include increased risk of hemorrhage and skin necrosis. Patients receiving warfarin must be counseled to discontinue the drug several days before any invasive procedure to allow time for the PT/INR levels to decrease to normal. Reversal of warfarin is achieved with vitamin K, fresh frozen plasma, or prothrombin-complex concentrates.16

Additional oral anticoagulants are now available and are commonly referred to as direct oral anticoagulants (DOACs). These agents work at specific targets in the coagulation cascade. Table 36.1 summarizes all of the oral anticoagulants currently available including target of action, uses, antidotes, and special considerations for each drug. Rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa) are direct factor Xa inhibitors. Dabigatran is a direct thrombin inhibitor. They are currently approved for the prevention of stroke in nonvalvular atrial fibrillation. Rivaroxaban and apixaban are also approved for short-term thromboprophylaxis after elective hip or knee surgery. All three agents may be used in the treatment of DVT or PE.18 Though these agents are not currently approved for treatment of arterial disease, patients may present on these medications due to comorbidities. The VOYAGER PAD trial looked at using rivaroxaban 2.5 mg twice daily with aspirin and was found to indicate a reduction in acute limb ischemia, amputation related to vascular disease, myocardial infarction (MI), ischemic stroke, and death from other cardiovascular events.19 More research is needed to determine if this is generalizable across all populations.

Table 36.1

Oral Anticoagulants
Drug Antidote Uses Stop Before Procedure Other Considerations
Apixaban (Eliquis)
Direct factor Xa inhibitor
Andexanet alfa (Andexxa) Stroke prevention in nonvalvular AFib
VTE prevention postop hip/knee replacement
DVT/PE prevention/treatment in recurrence
Low bleeding risk:
Last dose 2 days prior,
3 days if CrCL 15–29 mL/min
Moderate to high risk:
3 days,
4 days if CrCl 15–29 mL/min
BID dosing
Reduce dose 50% with strong CYP3A4 and p-glycoprotein inhibitors
(ketoconazole, itraconazole, ritonavir)
Avoid in severe liver disease
Dabigatran (Pradaxa)
Direct thrombin inhibitor
Stroke prevention in nonvalvular AFib
DVT/PE treatment
Low bleeding
risk: last dose 2 days prior, 3 days if CrCl 30–50 mL/min,
4–5 days if CrCl 15–29 mL/min;
Moderate to high risk: 3 days prior, 4–5 days if CrCl 30–50 mL/min, 6 days if CrCl 15–29 mL/min
BID dosing
Drug interactions similar to apixaban
Caution with amiodarone, verapamil, quinidine
Edoxaban (Savaysa)
Direct factor Xa inhibitor
Andexanet alfa (Andexxa) Stroke prevention in nonvalvular AFib
DVT/PE treatment
Low bleeding risk: last dose 2 days prior, 3 days if CrCl 15–29 mL/min
Moderate to high risk: 3 days, 4 days if CrCl 15–29 mL/min
Dose depends on renal function
Caution with concomitant antiplatelets
Avoid rifampin
Rivaroxaban (Xarelto)
Direct factor Xa inhibitor
Andexanet alfa (Andexxa) Stroke prevention in nonvalvular AFib
VTE prevention postop hip/knee replacement
DVT/PE prevention/treatment in recurrence
Low bleeding risk: last dose 2 days prior, 3 days if CrCl < 30 mL/min,
Moderate to high risk: 3 days, 4 days if CrCl < 30 mL/min
Drug interactions similar to apixaban
Strong CYP3A4 inducers (rifampin, carbamazepine, phenytoin)
Avoid in moderate to severe liver disease
Resume after oral intake is resumed
Warfarin (Coumadin)
Vitamin K antagonist
FFP, vitamin K, 4-factor PCC (Kcentra) VTE prevention/treatment
Stroke prevention in AFib and prosthetic heart valves
Secondary prevention post MI
Prevention of arterial thrombosis
5 days; may be individualized based on thrombotic and bleeding risk Preferred agent for CrCl < 15 mL/min and AFib with CAD, PAD
Bridging based on thrombotic and bleeding risk
Multiple drug/food interactions

AFib, Atrial fibrillation; BID, twice a day; CAD, coronary artery disease; DVT, deep venous thrombosis; FFP, fresh frozen plasma; MI, myocardial infarction; nl, normal; PAD, peripheral artery disease; PCC, prothrombin complex concentrate; PE, pulmonary embolism; VTE, venous thromboembolism.

From Christensen C, Lewis P. Core curriculum for vascular nursing. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2014; Comparison of oral anticoagulants. Prescriber’s Letter/Pharmacist’s Letter. December 2019; Agents for Reversing Anticoagulants. Nurse’s Letter/Hospital Pharmacist’s Letter. November 2018; Bridging Warfarin. Pharmacist’s Letter/Prescriber’s Letter. February 2019; Managing Bleeding With Anticoagulants. Pharmacist’s Letter/Prescriber’s Letter. September 2020.

IV direct thrombin inhibitors act at the active site of thrombin. These drugs provide an alternative to heparin in the patient with HIT. Current drugs available in this category include argatroban (Acova) and bivalirudin (Angiomax).20

Parenteral factor X inhibitors currently include only fondaparinux (Arixtra). Fondaparinux activates antithrombin III, leading to inactivation of factor X. It is administered subcutaneously and requires no laboratory monitoring. Its primary use is prevention of DVT and treatment of acute coronary syndromes. It may be used in patients unable to use LMWH or unfractionated heparin due to HIT. There is no reversal agent for fondaparinux.5,20

Antiplatelet agents include aspirin, cilostazol (Pletal), clopidogrel (Plavix), dipyridamole (Persantine), dipyridamole ER/aspirin (Aggrenox), prasugrel (Effient), ticagrelor (Brilinta), ticlopidine (Ticlid), and vorapaxar (Zontivity). These agents are summarized in Table 36.2. They may be used in the patient with vascular disease as a preventive measure for MI and stroke or as part of medical management for patients after placement of infrainguinal bypass grafts, carotid endarterectomy (CEA), and peripheral and carotid stenting.5,21 These drugs exhibit an irreversible permanent effect on the platelet for its life span and produce a qualitative effect on the platelet measured with the bleeding time. Platelet counts are not affected by these agents. Cilostazol also has some vasodilatory effects and is contraindicated in patients with heart failure. Patients should be counseled regarding the discontinuation of these drugs 5 to 10 days before invasive procedures to decrease the risk of bleeding.5,21 Patients at moderate to high risk for cardiovascular events may continue their antiplatelet agents to the time of surgery.21

Table 36.2

Oral Antiplatelets
Drug Antidote Uses Stop Before Procedure Other Considerations
Aspirin (ASA)
Cyclooxygenase inhibitor
Platelet transfusion AMI, stroke/TIA, angina, post CABG, stents, CEA 7 to 10 days Consider enteric coated for GI protection
Cilostazol (Pletal)
Phosphodiesterase III inhibitor
None Intermittent claudication 2 to 3 days CYP3A4 and CYP2C19 interactions
Contraindicated in CHF
Clopidogrel (Plavix)
ADP P2Y12 receptor inhibitor
Platelet transfusion ACS, stroke MI, PAD, PCI with ASA At least 5 days Efficacy affected by CYP2C19 inhibitors
Dipyridamole (Persantine)
Platelet adenosine uptake inhibitor
None VTE prevention post heart valve surgery with warfarin 2 to 3 days Dosed 4 times a day
Dipyridamole ER/ASA (Aggrenox)
Cyclooxygenase and platelet adenosine uptake inhibitor
None Secondary prevention of stroke, postischemic stroke, or TIA 5 to 10 days BID dosing
Prasugrel (Effient)
ADP P2Y12 receptor inhibitor
Platelet transfusion ACS with PCI 7 days Not recommended > 75 years of age
Contraindicated in stroke/TIA
Ticagrelor (Brilinta)
ADP P2Y12 receptor inhibitor
None ACS 5 days BID dosing
Consider if failed clopidogrel therapy
Do not administer with more than 100 mg ASA if using dual therapy
Ticlopidine (Ticlid)
ADP P2Y12 receptor inhibitor
Platelet transfusion Secondary stroke prevention if intolerant or failed ASA therapy 10 to 14 days BID dosing
Not first line
Neutropenia, thrombotic thrombocytopenic purpura
Vorapaxar (Zontivity)
Protease-activated receptor-1 (PAR-1) inhibitor
None Thrombotic prevention post MI, PAD with ASA, and/or clopidogrel 5 to 10 days Long half-life (5 to 13 days)
Contraindicated in stroke, TIA, ICH
Caution > 75 years of age or < 60 kg
Avoid strong CYP3A4 inhibitors and inducers

ACS, Acute coronary syndrome; AMI, acute MI; BID, twice a day; CABG, coronary artery bypass graft; CAD, coronary artery disease; CEA, carotid endarterectomy; ICH, intracerebral hemorrhage; MI, myocardial infarction; PAD, peripheral artery disease; PCI, percutaneous coronary intervention; TIA, transient ischemic attack.

From Comparison of oral antiplatelets. Pharmacist’s Letter/Prescriber’s Letter. November 2017.

Glycoprotein IIb/IIIa inhibitors are parenteral agents that also interfere with platelet aggregation and include abciximab (Reopro), eptifibatide (Integrilin), and tirofiban (Aggrastat). These agents are administered by IV infusion. Patients who have had drug-eluting coronary stent placement within the previous 12 months of a surgical procedure may need to be bridged with a glycoprotein IIb/IIIa inhibitor to discontinue their antiplatelet drugs for surgery or may be instructed to continue their aspirin and clopidogrel (Plavix) up to surgery.22

Preprocedural assessment

The PAD patient often presents with multiple comorbidities and/or risk factors including advanced age, tobacco use with or without chronic pulmonary disease, diabetes mellitus, impaired renal function, coronary artery disease, hypertension, and congestive heart failure.23 Optimizing the patient’s status before interventional and surgical procedures is vital to the outcome of the postoperative course. Cardiac risk, fluid management, pharmacotherapy, renal evaluation, and medical management of other comorbidities before surgery is vital to patient safety.23,24

The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) was developed as a means of cardiac risk prediction for patients undergoing noncardiac vascular surgery. The index includes nine variables that comprehensively evaluate cardiac risk in the vascular patient population. These variables are listed in Box 36.2. The index has been used to predict the cardiac risk in CEA, lower extremity bypass, endovascular repair of abdominal aortic aneurysm (AAA) repair, and open infrarenal AAA repair. Even though endovascular procedures may carry a lower risk of a cardiac event, patients should be stratified in the event that an endovascular procedure needs to be converted to an open procedure or additional procedures are required.23 The American Heart Association currently recommends that patients with intermediate or high cardiac risk undergo a cardiac stress test with exercise or pharmacologic agents and an electrocardiogram. Stress echocardiograms have been shown to be twice as accurate in predicting the postoperative occurrence of cardiac events and may be the best tool for evaluating cardiac risk. Some patients may require cardiac intervention before vascular surgery. Patients considered low risk for a postoperative event will require no further intervention.23 Surgery in patients who have undergone coronary stent placement should be delayed 4 to 6 weeks due to increased risk of stent thrombosis. Dual antiplatelet therapy should be continued before the surgery unless the bleeding risk outweighs the risk of thrombosis. For patients who have undergone placement of drug-eluting stents, surgery should be delayed for at least 6 months if possible.23

May 20, 2023 | Posted by in NURSING | Comments Off on Care of the Vascular Surgical Patient
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