Preoperative cardiac evaluation of the vascular surgery patient

The perioperative management of vascular surgery patients requires an understanding of the underlying pathophysiology of the specific vascular bed involved. A significant challenge derives from the high risk for operations in patients with overt or occult coronary artery disease (CAD), the primary cause of perioperative and long-term mortality after vascular surgery. We completed a reasoned revue of cardiac risk calculators to establish, for each patient, the risk level of an adverse cardiac event (MACE). A second important variable consists of laboratory blood investigation and a study of cardiac biomarkers. The next section reviews the importance of the electrocardiogram and of the echocardiogram. Finally it is important to optimize pharmacologically the patient, and, if required, to study his physiological responses to stress testing. This review presents the most recent data summarized from the last few years of publications. Accurate clinical assessment of the probability of CAD is essential for a rational approach. However, selective preoperative revascularization of the coronaries has not been shown to reduce perioperative or long-term mortality. Therefore, medical therapy is the key for the safe preparation of the patient: with the continuation of cardiovascular medication, optimization of antiplatelet therapy, and prevention of perioperative myocardial infarction.