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2015 ; 11
(ä): 379-85
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Preoperative optimization of the vascular surgery patient
#MMPMID26170688
Zhan HT
; Purcell ST
; Bush RL
Vasc Health Risk Manag
2015[]; 11
(ä): 379-85
PMID26170688
show ga
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.