New developments in the preoperative evaluation and perioperative management of coronary artery disease in patients undergoing vascular surgery Stephen.

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Presentation transcript:

New developments in the preoperative evaluation and perioperative management of coronary artery disease in patients undergoing vascular surgery Stephen M. Bauer, MD, Neal S. Cayne, MD, Frank J. Veith, MD Journal of Vascular Surgery Volume 51, Issue 1, Pages 242-251 (January 2010) DOI: 10.1016/j.jvs.2009.08.087 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Summary of the 2007 American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines as they pertain specifically to patients undergoing vascular surgery for the identification and management of patients at risk for cardiac complications. The clinical risk factors are based on the Lee index and are applied when the functional capacity of the patient cannot be assessed to determine clinical risk. Journal of Vascular Surgery 2010 51, 242-251DOI: (10.1016/j.jvs.2009.08.087) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Algorithm for the perioperative identification and perioperative management of patients with coronary artery disease (CAD) undergoing vascular surgery. Of note, medical management should be optimized in high-risk patients identified by the Lee index. The role of stress testing in these patients is currently unclear. The judgment by the vascular surgeon and the cardiologist must be applied and the indication for stress testing depends on the need for the vascular procedure and the severity of the CAD. We recommend a 30-day period to achieve the greatest benefit from medical management in high-risk patients with a positive stress test. Journal of Vascular Surgery 2010 51, 242-251DOI: (10.1016/j.jvs.2009.08.087) Copyright © 2010 Society for Vascular Surgery Terms and Conditions