oa Southern African Journal of Anaesthesia and Analgesia - Anaesthesia for vascular procedures : how do South African patients differ? : SASA refresher text
South African vascular anaesthetic practice is strongly influenced by European and American literature. This is inappropriate, as the prevalence and aetiology of cardiovascular disease, the aetiology of the vascular pathology, and the vascular surgical outcomes in South African patients differ from those reported internationally. South African vascular surgical patients are at higher cardiac risk and have a higher mortality than that reported in the international literature.
Although cardiac clinical risk predictors are probably consistent globally, the epidemiological transition of cardiovascular disease and the socioeconomic consequences of apartheid have had a profound influence on the â??weightingâ?? of these risk factors in South Africans. Of the South African race groups, South African Indians have the highest cardiac mortality, secondary to a high prevalence of renal dysfunction, diabetes and cerebrovascular accidents. South African black patients now have a similar cardiovascular burden to that reported internationally. The perioperative cardiac mortality of black South Africans is lower than international comparisons, probably secondary to a cardioprotective lipid profile of these patients. Black South Africans have an unacceptably high non-cardiac mortality associated with vascular surgery. Access to medical therapy for South African vascular surgical patients is wholly inadequate, as only a quarter of vascular patients are on statin therapy.
Nearly 6% of South African vascular patients present with Human Immunodeficiency Virus (HIV) vasculopathy of predominantly two distinct clinical presentations: aneurysmal and occlusive vascular disease. Aneurysmal disease is associated with a worse long-term prognosis. The poor access to highly-active anti-retroviral therapy (HAART) for these patients is unacceptable.
It is imperative that practice guidelines based on South African epidemiological data be established, that clinical cardiac and HIV risk indices be developed specifically for South African vascular patients, that socioeconomic issues affecting outcome between race groups be addressed, and that access to statin therapy and HAART be improved.
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