title: How to asses and improve cardiopulmonary risk prior to vascular surgery?
abstract: Patients with peripheral arterial disease have a high rate of cardiac, cerebrovascular, or pulmonary comorbidities. Peripheral arterial surgical interventions are associated with a moderate to high perioperative cardiac risk. Simple clinical scoring systems for preoperative risk stratification can be used to identify high-risk patients. In these patients further diagnostic and therapeutic measures are required to reduce perioperative morbidity and mortality. In contrast, a group of patients can be identifed that do not require additional cardiopulmonary diagnostics and can immediately proceed to the intervention. According to evidence-based recommendations in patients at risk beta blocker should be uptitrated and statin therapy should be initiated preoperatively. Quitting smoking preoperatively also reduces perioperative complications and should be encouraged in all patients.
authors.affiliation: Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität, Dresden, Germany.
authors.forename: Adrian
authors.initials: A
authors.lastname: Mahlmann
authors.forename: Roman N
authors.initials: RN
authors.lastname: Rodionov
authors.forename: Stefan
authors.initials: S
authors.lastname: Ludwig
authors.forename: Julia
authors.initials: J
authors.lastname: Neidel
authors.forename: Norbert
authors.initials: N
authors.lastname: Weiss
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000465:Algorithms; D000758:Anesthesia / Q000009:adverse effects; D015897:Comorbidity; D003661:Decision Support Techniques; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008171:Lung Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D018579:Patient Selection; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000601:surgery*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors