Acute Vascular the Elderly20Michael J. evolving demographic shift in the United in increasing numbers of elderly citizens all of healthcare. Emergency services now with geriatric patients who often present problems complicated by multiple comorbiditiesThe key to the successful management of surgical emergencies in the elderly is not only early diagnosis treatment but also aggressive management of multiple pre-existing major health problems. This is especially true in acute ischemia in the elderly. Delay is common in these patients despite the fact simple history and physical examination often are sufficient to make the diagnosis. These delays lead to and mortality because the elderly multiple serious comorbidities and limited reserve the sequelae of ischemia. The goal of this to provide a useful approach to the management vascular insufficiency in the elderly for the general surgeon. This review includes extremity acute arterial and venous occlusive presents algorithms and checklists to help direct diagnosis and management. Illustrative of each major etiology of acute conclude this chapter and provide an integration of the key elements of successful early prompt incidence of peripheral arterial disease (PAD), c disease (CAD), and cardiac arrhythmias among is extremely high and increasing yearly [1–4]Combined with the steadily rising life expectancy, of acute limb ischemia and acute mesenteric ischemia are of growing importance to acute care surgeonsMore than 25 % of the elderly have clinically active health problems related to PAD, CAD, or [3, 5]. Acute vascular insufficiency presents in of settings. Although the emergency the most common location to encounter , the ICU, medical-surgical floors, and the operating room may also be the site of consultation for . However, the work-up remains straightforward and is based upon a thorough history, an , adjunctive Doppler pressure measurements imaging studies, and, in a few compelling clinical settings, an immediate operation. The time urgency of diagnosis and effective treatment is based upon the “” of 6–8 h within which adequate blood flow must if limb-threatening tissue loss or necrosis is to be prevented. Acute limb ischemia more common than acute mesenteric ischemia a number of characteristics including etiology,.pathophysiology, and the need for immediate diagnosis [6, 7]Acute Limb . Sise, MD, of Surgery, UCSD School of Medicine, Scripps , 4077 5th Avenue MER-62, San Diego, CA 92103, : ; mjsise@, nontraumatic limb ischemia is usually due to source emboli or thrombotic occlusion of pre-.existing occlusive arterial disease. Although less common,.iatrogenic arterial occlusion is a growing problem for care surgeon [9]. Most, if not all of these patients, have© Springer International Publishing AG . Luchette, . Yelon (eds.), Geriatric Trauma and Critical Care, DOI comorbidities that complicate their management [10]Prompt diagnosis and treatment are essential to ischemia is the result of either acute arterial occlusion or acute worsening of chronic occlusive diseaseInfrequently, severe acute venous occlusion results in.ischemia secondary to arterial vasoc
