Preoperative evaluation and perioperative management of patients undergoing major vascular surgery

• Published in: Vascular medicine (London, England) Vol. 27; no. 5; pp. 496 - 512
• Main Authors: Lee, Christopher, Columbo, Jesse A, Stone, David H, Creager, Mark A, Henkin, Stanislav
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.10.2022; Sage Publications Ltd
• Subjects: Comorbidity; Congestive heart failure; Coronary artery; Coronary artery disease; Heart diseases; Patients; Review: Core Curriculum in Vascular Medicine; Risk analysis; Risk factors; Surgery; cardiac risk index; major adverse cardiovascular events; perioperative management; pre-operative evaluation; major vascular surgery
• ISSN: 1358-863X; 1477-0377; 1477-0377
• DOI: 10.1177/1358863X221122552

Patients undergoing major vascular surgery have an increased risk of perioperative major adverse cardiovascular events (MACE). Accordingly, in this population, it is of particular importance to appropriately risk stratify patients’ risk for these complications and optimize risk factors prior to surgical intervention. Comorbidities that portend a higher risk of perioperative MACE include coronary artery disease, heart failure, left-sided valvular heart disease, and significant arrhythmic burden. In this review, we provide a current approach to risk stratification prior to major vascular surgery and describe the strengths and weaknesses of different cardiac risk indices; discuss the role of noninvasive and invasive cardiac testing; and review perioperative pharmacotherapies.