Vascular surgery critical care: perioperative cardiac optimization to improve survival.

Abstract

To review the literature on perioperative cardiac management of patients who are scheduled to undergo vascular surgery. MEDLINE- and PubMed-based review of literature published from 1965 to 2005. Perioperative cardiac events (myocardial infarction, heart failure) remain the leading cause of morbidity and mortality in vascular surgery patients. Existing guidelines allow physicians to cost-effectively streamline preoperative cardiac risk assessment and stratification. Perioperative optimization of volume status and cardiac function and the routine use of perioperative beta-blockers can significantly improve outcomes after major vascular surgery. Perioperative addition of statins to beta-blockers in high-risk patients undergoing vascular surgery merits further evaluation. Preoperative coronary revascularization should be restricted to patients with unstable cardiac symptoms.