Risk of cardiac complications in patients undergoing major vascular surgery

In patients undergoing major vascular surgery cardiac complications are the major cause of perioperative morbidity and mortality. This is related to the frequent presence of underlying coronary artery disease. The aim of the preoperative cardiac risk assessment is to evaluate the presence and degree of coronary artery disease along with other risk factors such as cerebrovascular disease, renal insufficiency, and diabetes mellitus that may influence the perioperative risk of these patients. Based on the presence and number of cardiac risk factors the individual risk profile can be determined, which may facilitate medical decision making about the perioperative and long-term management of these patients. In the present review based on data from current literature we summarized the pathology of perioperative cardiac complications, and the role of cardiac risk assessment and risk reduction strategies in patients undergoing major vascular surgery. In this review the authors summarized data from current literature and found that a limited set of risk factors and a result of a noninvasive test used for detection of coronary artery disease may help to stratify patients into low-, intermediate- and high risk for perioperative cardiac complications. If patients with intermediate- to high-risk prescribed beta-blockers the risk of cardiac complications can be reduced. Along with beta-blockers it was also found that perioperative use of statins may also help to reduce the risk of cardiac complications. In patients identified to be at very high-risk further perioperative evaluation and management should include coronary angiography with subsequent coronary revascularization if there is a clearly defined need, independent of the need for vascular surgery.