What Are Vascular Emergencies?

A former member and co-chair of the Society for Vascular Surgery International Relations Committee, Dr. Robert Crawford possesses board certification in surgical critical care, general surgery, and vascular surgery. Dr. Robert Crawford combines his experience in vascular surgery and critical care as a proponent of the creation of stand alone, independent vascular acute care surgery (VACS) services.

Within the field of vascular surgery, vascular emergencies pose a particular challenge. The concept of time-sensitive disease applies to vascular emergencies as it applies to heart attacks, strokes and various other emergencies. Depending on the specific problem, without immediate medical attention, a patient may risk severe blood loss, limb loss, or death.

Limb loss from acute limb ischemia, cardiovascular collapse from acute pulmonary embolisms, aortic aneurysms resulting in life threatening blood loss, aortic dissections, acute deep venous thrombosis are some of the pathologies that can be categorized as vascular emergencies. These patients often require care that goes beyond the initial treatment of their vascular problem. These patients usually have long hospital stays, require repeat trips to the operating room and also require complicated intensive care unit admission. These patients tend to be critically ill and require constant evaluation and vigilance for possible repeat procedures. In order to improve care, the establishment of a separate team, one that is not burdened with the care of elective patients and other responsibilities has been advocated. Early data, published from aggregate databases support the idea that acute care vascular burden of disease is significant. It also further supports the idea that early transfer of these patients to referral centers that posses such services improves care. Finally, early data from Dr Crawford while at Maryland shows that the establishment of dedicated vascular service reduces length of stay and decreases cost in this population. This model, which mirrors what occurred when acute care general surgery separated as a stand alone service from general surgery, will need to evolve. It will include its own societal structure, research focus and validation of its effectiveness. Dr Crawford and colleagues argued, at a presentation at the American College of surgeons and in a review published in Current Surgery Reports that establishment of of Vascular Acute Care Surgery services will improve care for vascular patients going forward.

In order to better deal with these types of cases, a few major medical cxenters have established stand alone teams