In the last five years, vascular surgery has undergone a considerable change in emphasis with respect to the breadth of conditions being treated and in the techniques used in therapy. The evidence base for vascular surgical intervention has broadened considerably, particularly in the fields of carotid intervention and the treatment of abdominal and thoracic aortic aneurysms. This newly gathered evidence base has been used to further define the indications for vascular reconstruction.

The emphasis on the development of new techniques for vascular intervention has continued, with the focus on minimally invasive and endovascular therapy. The application of endovascular therapy for the treatment of aortic and carotid disease is still largely confined to specialist centres but these techniques are likely to represent the future of vascular intervention. The change in direction of traditional vascular surgery has significant implications for anaesthetic practice as most of the newer vascular techniques are amenable to loco-regional anaesthesia. This chapter reviews the most recent advances in vascular practice for the treatment of aortic disease, carotid artery stenosis and varicose veins.

Advances in the treatment of abdominal aortic aneurysms

Aortic aneurysms are responsible for 13 000 deaths in the UK, with abdominal aneurysms causing 8000 of these. The principles that guide aneurysm treatment are to detect aneurysms prior to rupture, to electively repair these aneurysms with the lowest possible mortality and to treat the complications of aneurysmal disease (primarily rupture). Unfortunately, the majority of aneurysms are asymptomatic and many rupture before elective surgical repair can be contemplated.