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Preoperative cardiac risk management.

William C Krupski¹, Mark R Nehler, Thomas A Whitehill

¹The Division of Vascular Surgery, Department of Surgery, University of Colorado Health Sciences Center and The Denver Department of Veterans Affairs Medical Center, Denver, Colorado, USA.

Cardiovascular Surgery (London, England)

|October 3, 2002

Summary

Extensive preoperative cardiac testing before vascular surgery can lead to complications and patients refusing necessary operations. Careful consideration of risks versus benefits is crucial before cardiac evaluation.

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Area of Science:

Cardiology
Vascular Surgery
Medical Outcomes

Background:

Preoperative cardiac testing is common before vascular operations, but its adverse effects are not always considered.
A study analyzed adverse outcomes of cardiac evaluation and intervention in patients undergoing vascular surgery at a Veterans Affairs Medical Center.

Discussion:

The decision for cardiac evaluation was made without a defined protocol, leading to varied approaches.
A significant percentage of patients experienced adverse events during or after cardiac evaluation and intervention.
Some patients refused essential vascular surgery following cardiac screening and/or intervention.

Key Insights:

Thirty-eight percent of patients undergoing comprehensive preoperative cardiac evaluations experienced untoward events.

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Nineteen percent of patients refused vascular surgery after cardiac screening or intervention.

Complications included graft infection, pseudoaneurysms, wound infections, amputations, renal failure, and brain anoxia.

Outlook:

Extensive cardiac evaluation before vascular surgery can cause morbidity, delays, and patient refusal of treatment.
The decision to order cardiac studies should weigh the vascular operation's indication against local iatrogenic cardiac complication rates.