Preoperative cardiac evaluation of the patient with vascular disease

To review the literature and evaluate the investigation of cardiac risk factors, by tests and intraoperative predictors, that will identify patients at high risk for vascular surgery.

An English-language literature review of Index Medicus articles from 1961 to 1992.

Published articles that addressed preoperative risk factors, diagnostic tests and intraoperative predictors were selected by multiauthor consensus.

Independent extraction by multiple authors was utilized to abstract and assess the quality of data from selected references, with consensus determining inclusion or exclusion.

From evaluation of published data, a number of factors were considered to put a patient scheduled to undergo vascular surgery at higher risk: symptomatic coronary artery disease; clinical evidence of coronary artery disease, congestive heart failure, aortic stenosis and recent myocardial infarction; laboratory findings of significant disease with cardiomegaly or significant dysrhythmias; and no symptoms but two or more risk factors.

The authors propose an algorithm for the investigation of patients and stratification of risk to be considered in weighing the dangers versus the benefits of vascular surgery.