Safety of peripheral vascular surgery after recent acute myocardial infarction

We have treated 30 patients requiring urgent or emergent vascular procedures in the first 6 weeks after a myocardial infarction (median 11 days) from 1977 through 1989. Forty operations were performed, including 28 lower extremity revascularizations, 10 major amputations and revisions, and two carotid endarterectomies. There were four postoperative deaths (three cardiac related) and two nonfatal reinfarctions. Cardiac complications did not correlate with age, interval from myocardial infarction to surgery within the initial 6 weeks, type of anesthesia, or complexity of operation. Twenty of 24 patients survived attempts at leg revascularization, with ultimate limb salvage in 16. Our cardiac complication rate of 17% (5/30 patients) was reasonably close to that predicted by the Goldman risk scale for classes II and III and significantly better than class IV and also better than that predicted by the Cooperman risk scale for vascular surgery, despite the more recent preoperative myocardial infarctions in our patients. We attribute our low morbidity and mortality to the extracavitary nature of the procedures and possibly to improvements in anesthetic and perioperative management. Patients requiring urgent revascularization for limb salvage should not be denied surgery on the basis of a recent myocardial infarction.