Do vascular surgery patients need a cardiology work-up? A review of pre-operative cardiac clearance guidelines in vascular surgery.
OBJECTIVE
to outline the appropriate pre-operative cardiac work-up for patients who are scheduled for major peripheral vascular surgery.


METHODS
review of the literature.


METHODS
a review of the literature focusing on studies that have correlated the pre-operative cardiac work-up patients receive to the cardiac morbidity and mortality following vascular surgery. Only studies with level A evidence were included.


RESULTS
peri-operative beta blockade has been shown to decrease cardiac complications after vascular surgery in all risk groups. Non-invasive cardiac testing is only necessary for patients in the intermediate/high risk group. Coronary revascularization should only be considered after a positive non-invasive cardiac test.


CONCLUSIONS
patients must be risk stratified pre-operatively based on history and physical examination. Low risk patients should receive peri-operative beta blockade only with no further non-invasive testing. On the other hand, intermediate and high risk patients should undergo non-invasive cardiac testing before going to the operating room.
Abir
Farshad
F
Department of Vascular Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, U.S.A.
Kakisis
Iannis
I
Sumpio
Bauer
B
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000465:Algorithms; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards*; D006801:Humans; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000592:standards*; D018570:Risk Assessment; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards
D000319:Adrenergic beta-Antagonists