title: Preoperative optimization of the vascular surgery patient.
abstract: It is well known that patients who suffer from peripheral (noncardiac) vascular disease often have coexisting atherosclerotic diseases of the heart. This may leave the patients susceptible to major adverse cardiac events, including death, myocardial infarction, unstable angina, and pulmonary edema, during the perioperative time period, in addition to the many other complications they may sustain as they undergo vascular surgery procedures, regardless of whether the procedure is performed as an open or endovascular modality. As these patients are at particularly high risk, up to 16% in published studies, for postoperative cardiac complications, many proposals and algorithms for perioperative optimization have been suggested and studied in the literature. Moreover, in patients with recent coronary stents, the risk of non-cardiac surgery on adverse cardiac events is incremental in the first 6 months following stent implantation. Just as postoperative management of patients is vital to the outcome of a patient, preoperative assessment and optimization may reduce, and possibly completely alleviate, the risks of major postoperative complications, as well as assist in the decision-making process regarding the appropriate surgical and anesthetic management. This review article addresses several tools and therapies that treating physicians may employ to medically optimize a patient before they undergo noncardiac vascular surgery.
authors.affiliation: Texas A&M Health Science Center College of Medicine, Bryan, TX, USA.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Zhan
authors.affiliation: Texas A&M Health Science Center College of Medicine, Bryan, TX, USA ; Baylor Scott and White, Temple, TX, USA.
authors.forename: Seth T
authors.initials: ST
authors.lastname: Purcell
authors.affiliation: Texas A&M Health Science Center College of Medicine, Bryan, TX, USA.
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Bush
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000572:American Heart Association; D015897:Comorbidity; D025401:Echocardiography, Stress; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects
chemical_list: D000319:Adrenergic beta-Antagonists; D010975:Platelet Aggregation Inhibitors
keywords: intraoperative care; medical management; medical treatment; perioperative care; risk evaluation/stratification