Preoperative cardiovascular evaluation in patients undergoing vascular surgery.

Vascular surgery is associated with a higher incidence of perioperative cardiovascular morbidity and mortality compared with other noncardiac surgeries. Patients undergoing vascular surgery represent a higher-risk population, usually because of the presence of generalized arterial disease and multiple comorbidities. The overwhelming perioperative cardiac event is myocardial infarction. This article offers a tailored approach to preoperative cardiovascular management for patients undergoing vascular surgery. The use and limitations of well-established guidelines and clinical risk indices for patients undergoing noncardiac surgery are described as it pertains to vascular surgery in particular. Furthermore, the role and benefit of noninvasive stress testing, coronary revascularization, and medical therapy before vascular surgery are discussed.