Peripheral arterial occlusive disease and perioperative risk

Surgical procedures represent a risk for different complications which may appear during the perioperative period. Cardiac ischemic events and vascular complications are the most important causes of increased morbidity and mortality and they are much more frequent in patients with manifest cardiovascular disease. This is particularly seen in patients with peripheral arterial occlusive disease (PAD), which represents advanced atherosclerosis frequently accompanied by the presence of coronary artery disease. Therefore, patients with PAD need careful preoperative examination, including estimation of functional capacity and the presence of other co-existing atherosclerotic diseases. The perioperative risk of cardiac complications should be calculated by Apgar score. In patients with unstable coronary syndrome myocardial revascularization should be performed before vascular procedures, whereas in other coronary patients pharmacotherapy should be intensified. The latter includes beta-adrenergic receptor blockers, statin therapy, which significantly improves postoperative outcome and antiplatelet drugs, which do not significantly increase major bleeding complications but significantly reduce cardiovascular thromboembolic events. Postoperative strategy for prevention of complications should be focused particularly on identification of myocardial infarction which is frequently asymptomatic. Therefore, serial postoperative measurements of troponin levels allow close monitoring of postoperative myocardial damage and help to implement strategic choices for the treatment of postoperative adverse cardiac events.