In recent years, innovations in surgical and procedural technology have greatly changed anesthesia practice. A classic example is vascular surgery. Traditionally, a vascular surgeon performed procedures in an open fashion, which was typically very invasive for the patient. The anesthesiologist had to safely manage patients – who often had significant comorbidities – through a great amount of fluid shifts, other physiological changes and surgical stress. This required general anesthesia, invasive monitors (i.e., arterial lines, central lines), blood transfusions and significant hemo-dynamic maneuvering. The introduction of minimally invasive procedures provided alternatives to traditional open surgery. Endovascular repair (EVAR) is an alternative to open repair for abdominal aortic aneurysms (AAA), percutaneous interventions such as balloon angioplasty and stenting are an alternative to open bypass in patients with peripheral vascular disease, and carotid stenting is an alternative to carotid endarterectomy. As a result, the anesthesiologist often has fewer physiological perturbations to manage. In fact, many of these procedures do not even require general anesthesia.