Preoperative cardiac evaluation of the patient with vascular disease.
OBJECTIVE
To review the literature and evaluate the investigation of cardiac risk factors, by tests and intraoperative predictors, that will identify patients at high risk for vascular surgery.


METHODS
An English-language literature review of Index Medicus articles from 1961 to 1992.


METHODS
Published articles that addressed preoperative risk factors, diagnostic tests and intraoperative predictors were selected by multiauthor consensus.


METHODS
Independent extraction by multiple authors was utilized to abstract and assess the quality of data from selected references, with consensus determining inclusion or exclusion.


RESULTS
From evaluation of published data, a number of factors were considered to put a patient scheduled to undergo vascular surgery at higher risk: symptomatic coronary artery disease; clinical evidence of coronary artery disease, congestive heart failure, aortic stenosis and recent myocardial infarction; laboratory findings of significant disease with cardiomegaly or significant dysrhythmias; and no symptoms but two or more risk factors.


CONCLUSIONS
The authors propose an algorithm for the investigation of patients and stratification of risk to be considered in weighing the dangers versus the benefits of vascular surgery.
Maziak
D E
DE
Department of Surgery, University of Toronto, St. Joseph's Health Centre, Ont.
Ralph-Edwards
A C
AC
Deitel
M
M
Wooster
D L
DL
D000367:Age Factors; D000465:Algorithms; D006334:Heart Function Tests / Q000379:methods; D006801:Humans; D007430:Intraoperative Care; D011300:Preoperative Care; D011379:Prognosis; D012307:Risk Factors; D014652:Vascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery