How Optimal is the Medical Management of Patients Prior to Major Reconstructive Vascular Surgery? The Results of a Cross-sectional Study

BACKGROUND: Risk factor modification is important in patients with vascular disease. Guidelines suggest that this patient population benefits from a medical regimen of antiplatelets, statins, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors. MATERIALS AND METHODS: The medical regimen of consecutive patients who presented for major vascular surgery intervention over 18 months was examined. RESULTS: Of the 325 patients identified, 176 (54%) were on antiplatelet treatment, 197 (61%) were on a statin, 180 (55%) on beta-blockers, and 146 (54%) on ACE inhibitors. A high-risk subset of 94 smokers with known coronary artery disease, hypertension, and hyperlipidemia or diabetes was identified. In this subset, patients were more likely to be on pharmacologic risk factor modification. CONCLUSIONS: Despite recommendations, the pharmacologic risk factor modification of patients prior to vascular surgery remains suboptimal. Increased awareness of the problem and active participation of the vascular specialist are essential to improve compliance with established guidelines.