Peripheral Arterial Disease (PAD)

High cardiovascular risk - Treat PAD as a coronary-disease equivalent: assume CAD, optimize and continue statins, antiplatelets, and beta-blockers, and manage the myocardial oxygen supply-and-demand balance.

Limb perfusion and positioning - Ischemic limbs tolerate pressure and malposition poorly; pad carefully and maintain perfusion pressure.

Vascular surgery specifics - Revascularization involves heparinization, potential blood loss, and clamp-related hemodynamic swings; plan access and monitoring accordingly.

Diabetes and renal disease - Commonly coexist; manage glucose and protect the kidneys from contrast and hypotension.

Regional anesthesia - Often used for distal procedures and can improve graft flow, but weigh it against antiplatelet and anticoagulant status.

Peripheral arterial disease is atherosclerotic narrowing of the arteries to the limbs and a marker of systemic atherosclerosis. The same disease that narrows leg arteries narrows the coronaries and carotids.

So PAD patients carry a high burden of coexisting coronary and cerebrovascular disease, diabetes, hypertension, and smoking-related illness. Perioperative concerns are dominated by that cardiovascular risk, plus perfusion of ischemic limbs, positioning, and — for revascularization — blood loss and anticoagulation.