title: Preoperative cardiac evaluation of the vascular surgery patient--an anesthesia perspective.
abstract: The morbidity and mortality associated with vascular surgery procedures are largely the results of cardiac events. National guidelines have been regularly proposed and updated by the American College of Cardiology (ACC)/American Heart Association (AHA) to ensure optimal perioperative management and risk stratification. Controversy remains between experts and other cardiology societies regarding several patient care issues including revascularization before surgery, timing of β-blocker therapy, and the administration of antiplatelet therapy. Several landmark articles recently published have helped to modify the guidelines in the hope of improving vascular patient outcomes. In this review, we searched all recent available literature pertaining to perioperative cardiac evaluation before major vascular surgery. We propose an algorithm for preoperative cardiac evaluation, which is a modification to the AHA recommendations. Incorporated in this algorithm are recent published pivotal articles that can help in guiding physicians caring for the vascular patient requiring major operative or endovascular interventions.
authors.affiliation: Internal Medicine Department, Mercy Hospital and Medical Center, Chicago, IL, USA.
authors.forename: Hesham R
authors.initials: HR
authors.lastname: Omar
authors.forename: Devanand
authors.initials: D
authors.lastname: Mangar
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Camporesi
mesh_terms: D000465:Algorithms; D000758:Anesthesia / Q000009:adverse effects / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D057510:Endovascular Procedures; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006334:Heart Function Tests; D006801:Humans; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
chemical_list: D002317:Cardiovascular Agents