Preoperative risk assessment in patients with peripheral vascular disease referred for noncardiac surgery

Patients with peripheral vascular disease are at increased risk for perioperative cardiac events. Various strategies for risk stratification have been recommended to optimize patient care. Preoperative cardiac evaluation involves integrating knowledge of the risk of the surgical procedure with known clinical factors and the results of noninvasive testing. Preoperative assessment should: a) identify patients at extremely high risk for whom the planned surgery should be canceled or altered; b) identify patients with correctable medical problems who may benefit from medical optimization or coronary revascularization to try to decrease risk; c) determine which patients may benefit from invasive or intensive monitoring; and d) assess long-term cardiac risk, as this may affect the choice of procedure. A review of the literature on this topic is provided, and a patient management algorithm is presented.