Related Experiment Video
Updated: Apr 21, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Perioperative clinical variables and long-term survival following vascular surgery
Santiago Garcia1, Edward O McFalls1
1Santiago Garcia, Minneapolis VA Healthcare System, University of Minnesota, MN 55417, United States.
Insights
Peripheral arterial disease (PAD) patients often have coexisting coronary artery disease (CAD). Universal cardiac troponin surveillance after high-risk surgery may be more effective than routine cardiac imaging for managing peri-operative myocardial ischemia.
Area of Science:
- Cardiology
- Vascular Surgery
- Peri-operative Medicine
Background:
- Cardiovascular disease (CVD) is the primary cause of mortality in peripheral arterial disease (PAD) patients.
- Coronary artery disease (CAD) frequently coexists with PAD, complicating management.
- High-risk vascular surgery in PAD patients necessitates careful risk stratification and medical optimization.
Purpose of the Study:
- To evaluate risk stratification and peri-operative management strategies for PAD patients undergoing high-risk surgery.
- To assess the efficacy of preventive revascularization versus active surveillance for peri-operative cardiac complications.
- To determine the role of cardiac troponin surveillance and imaging in managing myocardial ischemia.
Main Methods:
- Review of current guidelines and evidence for managing PAD patients with coexisting CAD undergoing major vascular surgery.
- Analysis of the effectiveness and risks of preventive revascularization versus medical management.
- Evaluation of peri-operative cardiac troponin surveillance as an alternative to routine cardiac imaging.
Main Results:
- Preventive revascularization for stable CAD in PAD patients undergoing surgery is not effective and carries bleeding/thrombotic risks.
- Universal peri-operative cardiac troponin surveillance may be more reasonable and cost-effective than widespread cardiac imaging.
- Elevated post-operative cardiac troponin predicts long-term mortality; aspirin and statins are recommended.
Conclusions:
- Risk stratification using revised cardiac risk index and optimized medical therapy are crucial for PAD patients undergoing high-risk surgery.
- Active surveillance with cardiac troponins is a potentially superior strategy to routine imaging for peri-operative myocardial ischemia.
- Further research is needed on cardiac imaging and angiography in this high-risk population.
Abstract:
Cardiovascular disease is the leading cause of death in patients with peripheral arterial disease (PAD). Coronary artery disease (CAD) is highly prevalent, and often times coexist, in patients with PAD. The management of patients with PAD that requires a high-risk vascular surgical procedure for intermittent claudication, critical limb ischemia or expanding abdominal aortic aneurysm requires risk stratification with the revised cardiac risk index, optimization of medical therapies, and limited use of cardiac imaging prior to surgery. Preventive revascularization in patients with stable CAD, with the sole intention to mitigate the risk of cardiac complications in the peri-operative period, is not effective and may be associated with significant bleeding and thrombotic risks, in particular if stents are used. A strategy of universal use of cardiac troponins in the perioperative period for active surveillance of myocardial ischemia may be more reasonable and cost-effective than the current standard of care of widespread use of cardiac imaging prior to high-risk surgery. An elevated cardiac troponin after vascular surgery is predictive of long-term mortality risk. Medical therapies such as aspirin and statins are recommended for patients with post-operative myocardial ischemia. Ongoing trials are assessing the role of novel anticoagulants. Additional research is needed to define the role of cardiac imaging and invasive angiography in this population.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:22Aneurysm IV: Nursing Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:26Peripheral Artery Disease IV: Nursing Management