Vascular surgery critical care: Perioperative cardiac optimization to improve survival

OBJECTIVE: To review the literature on perioperative cardiac management of patients who are scheduled to undergo vascular surgery. DATA SOURCE: MEDLINE- and PubMed-based review of literature published from 1965 to 2005. CONCLUSIONS: Perioperative cardiac events (myocardial infarction, heart failure) remain the leading cause of morbidity and mortality in vascular surgery patients. Existing guidelines allow physicians to cost-effectively streamline preoperative cardiac risk assessment and stratification. Perioperative optimization of volume status and cardiac function and the routine use of perioperative beta-blockers can significantly improve outcomes after major vascular surgery. Perioperative addition of statins to beta-blockers in high-risk patients undergoing vascular surgery merits further evaluation. Preoperative coronary revascularization should be restricted to patients with unstable cardiac symptoms.