Does Defensive Medicine Change the Behaviors of Vascular Surgeons? A Qualitative Review
Table 1
Vascular surgery pathologies: carotid stenosis, aortic aneurysms, aortic dissections, and peripheral arterial disease, evaluated in the light of the indication, timing, and technique.
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Indication
Timing
Techniques
Carotid stenosis
To treat symptomatic stenosis or only haemodynamic asymptomatic lesions
Within 24 hours from symptoms onset or within 14 days
Carotid endarterectomy or carotid artery stenting
Aortic aneurysms
To treat on the basis of the diameter or on the basis of accompanying symptoms and/or aortic morphology
In case of symptoms: as soon as possible or after careful patient evaluation
Open repair or endovascular repair
Aortic dissections
To treat all the dissection or selectively on the basis of visceral malperfusion, aneurismatic dilatation, and uncontrolled pain and hypertension
Within 15 days from symptoms onset or after 15 days
Open repair or endovascular repair
Peripheral arterial disease
To treat patients presenting with claudication or only patients with critical limb ischemia
Critical limb ischemia presenting patient should always be treated in urgent/emergent setting
Open repair or endovascular repair. In case of endovascular repair, use or do not use stent, covered stent, and drug eluting devices
To recognize patients presenting with acute limb ischemia