Evaluation and Medical Management of the Vascular Surgery Patient

  • Khether E. Raby


Patients with peripheral vascular disease have a high prevalence of coronary artery disease. Coronary artery disease is often occult, and its activity is difficult to measure by conventional means. For these reasons, coronary artery disease is by far the most important factor contributing to morbidity and mortality in vascular surgery patients.


Abdominal Aortic Aneurysm Abdominal Aortic Aneurysm Coronary Revascularization Cardiac Risk Dobutamine Stress Echocardiography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hertzer NR, Beven EG, Young JR, Coronary artery disease in peripheral vascular patients: a classification of 1000 coronary angiograms and results of surgical management. Ann Surg 1984, 199:223–233.Google Scholar
  2. 2.
    Criqui MH, Langer RD, Fronek A, Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992, 329:381–386.Google Scholar
  3. 3.
    Vogt MT, Cauley JA, Newman AB, Decreased ankle/brachial blood pressure index and mortality in elderly women. JAMA 1993, 270:465–469.Google Scholar
  4. 4.
    Rosenfeld BA, Beattie C, Christopherson R, The effects of different anesthetic regimens on fibrinolysis and the development of postoperative arterial thrombosis. Anesthesiology 1993, 79:435–443.Google Scholar
  5. 5.
    Jamieson WI, Janusz MT, Miyagishima RT, Gerein AN: Influence of ischemic heart disease on early and late mortality after surgery for peripheral occlusive vascular disease. Circulation 1982,66:1–92-I-98.Google Scholar
  6. 6.
    Hertzer NR: The natural history of peripheral vascular disease. Circulation 1991,83:1–12–1–19.Google Scholar
  7. 7.
    Hollier LH, Plate G, O’Brien PC, Late survival after abdominal aortic aneurysm repair: influence of coronary artery disease I Vasc Surg 1984,1:290–299.Google Scholar
  8. 8.
    Golden MA, Whittemore AD, Donaldson MC, Mannick JA: Selective evaluation and management of coronary artery disease in patients undergoing repair of abdominal aortic aneurysms. Ann Surg 1990, 212: 415–423.PubMedCrossRefGoogle Scholar
  9. 9.
    Donaldson MC, Mannick JA, Whittemore AD: Femoral-distal bypass with in situ greater saphenous vein: long-term results using the Mills valvulotome. Ann Surg 1991, 213: 457–465.PubMedCrossRefGoogle Scholar
  10. 10.
    Bunt TJ: The role of a defined protocol for cardiac risk assessment in decreasing perioperative myocardial infarction in vascular surgery. J Vasc Surg 1992, 15: 626–634.PubMedCrossRefGoogle Scholar
  11. 11.
    Bartels JF, Bechtell M, Hossmann V, Svante H: Cardiac risk stratification for high-risk surgery. J Vasc Surg 1992, 15: 626–634.Google Scholar
  12. 12.
    Detsky AS, Abrams HB, McLaughlin JR, Predicting cardiac complications in patients undergoing noncardiac surgery. J Gen Intern Med 1981,141:1631–1634.Google Scholar
  13. 13.
    Lee TH, Marcantonio ER, Mangione CM, Derivation and prospective validation of a simple index for prediction of cardiac risk in major noncardiac surgery. Circulation 1999,100:1043–1049.Google Scholar
  14. 14.
    Eagle KA, Coley CM, Newell JB, Combining clinical and thallium data optimizes preoperative assessment of cardiac risk for major vascular surgery. Ann Intern Med 1989, 110:859–866.Google Scholar
  15. 15.
    McPhail N, Calvin JE, Shariatmadar A, The use of preoperative exercise testing to predict cardiac complications after arterial reconstruction. J Vasc Surg 1988, 7:60–68.Google Scholar
  16. 16.
    Gauss A, Rohm HJ, Schauffelen A, Electrocardiographic exercise stress testing for cardiac risk assessment in patients undergoing noncardiac surgery. Anesthesiology 2001, 94:38 46.Google Scholar
  17. 17.
    IV Persantine, Physician’s Guide. Billerica, MA: Dupont-Merck Pharmaceuticals. Serial #MF-100/8362; pp. 4–5.Google Scholar
  18. 18.
    Levinson JR, Boucher CA, Coley CM, Usefulness of semi-quantitative analysis of dipyridamole-thallium 201 redistribution for improving risk stratification before vascular surgery. Am J Cardiol 1990, 66:406–410.Google Scholar
  19. 19.
    Boucher CA, Brewster DC, Darling RC, Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery. N Engl J Med 1985, 312:389–394.Google Scholar
  20. 20.
    Baron JF, Mundler O, Bertrand M, Dypridamole-thallium scintigraphy and gated radionuclide angiography to assess cardiac risk before abdominal aortic surgery. N Engl J Med 1994, 330:663–996.Google Scholar
  21. 21.
    Marcovitz PA, Armstrong WF: Accuracy of dobutamine stress echocardiography in detecting coronary artery disease. Am J Cardiol 1992, 69: 1269–1273.PubMedCrossRefGoogle Scholar
  22. 22.
    Poldermans D, Fioretti PM, Forster T, Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery. Circulation 1993, 87:1506–1512.Google Scholar
  23. 23.
    Raby KE, Goldman L, Creager MA, Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med 1989, 321:1296–1300.Google Scholar
  24. 24.
    Mangano DT, Browner WS, Hollenberg M, Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med 1990, 323:1781.Google Scholar
  25. 25.
    Pasternack PF, Grossi EA, Baumann FG, Silent myocardial ischemia monitoring predicts late as well as perioperative cardiac events in patients undergoing vascular surgery. J Vasc Surg 1992, 16:171–180.Google Scholar
  26. 26.
    Fleisher LA, Rosenbaum SH, Nelson AH, Barash PG: The predictive value of preoperative silent ischemia for postoperative ischemic cardiac events in vascular and nonvascular surgery patients. Am Heart J 1991, 122: 980–985.PubMedCrossRefGoogle Scholar
  27. 27.
    Raby KE, Barry J, Creager MA, Detection and significance of intraoperative and postoperative ischemia in peripheral vascular surgery. JAMA 1992, 268:222–227.Google Scholar
  28. 28.
    Landesberg G, Luria MH, Cotev S, Importance of long-duration postoperative ST-segment depression in cardiac morbidity after vascular surgery. Lancet 1993, 341:715–719.Google Scholar
  29. 29.
    McCann RL, Clements FN: Silent myocardial ischemia in patients undergoing peripheral vascular surgery: incidence and association with perioperative cardiac morbidity and mortality. J Vasc Surg 1989, 9: 583–587.PubMedGoogle Scholar
  30. 30.
    Ouyang P, Gerstenblith G, Furman WI, Frequency and significance of early postoperative silent myocardial ischemia in patients having peripheral vascular surgery. Am J Cardiol 1989, 64:1113.Google Scholar
  31. 31.
    Ganz L, Andrews TC, Barry J, Raby KE: Silent ischemia preceding sudden cardiac death in a patient after vascular surgery. Am Heart J 1994, 127: 1652–1654.PubMedCrossRefGoogle Scholar
  32. 32.
    Andrews TC, Goldman L, Creager MA, Identification and treatment of perioperative myocardial ischemia in patients undergoing peripheral vascular surgery. J Vasc Med Biol 1994, 5:8–15.Google Scholar
  33. 33.
    Pasternack PF, Imparato AM, Baumann FG, The hemodynamics of beta-blockade in patients undergoing abdominal aortic aneurysm repair. Circulation 1987,76:1111–1117.Google Scholar
  34. 34.
    Mangano DT, Layug EL, Wallace A, Tateo I: Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 1996, 335 (23): 1713–1720.PubMedCrossRefGoogle Scholar
  35. 35.
    Wallace A, Layug B, Tateo I, Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group. Anesthesiology 1998, 88(1):7–17.Google Scholar
  36. 36.
    Poldermans D, Boersma E, Bax JJ, The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 1999, 341(24):1789–1794.Google Scholar
  37. 37.
    Raby KE, Brull SJ, Timimi F, The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg 1999, 88(3):477–482.Google Scholar
  38. 38.
    Hassan SA, Hlatky MA, Boothroyd DB, Outcomes of noncardiac surgery after coronary bypass surgery or coronary angioplasty in the Bypass Angioplasty Revascularization Investigation (BARI). Am J Med 2001,110(4):260–266.Google Scholar
  39. 39.
    Fleisher LA, Skolnick ED, Holroyd KJ, Lehmann HP: Coronary artery revascularization before abdominal aortic aneurysm surgery: a decision analytic approach. Anesth Analg 1994, 79: 661–669.PubMedGoogle Scholar
  40. 40.
    Wong T, Detsky AS: Preoperative cardiac risk assessment for patients having peripheral vascular surgery. Ann Intern Med 1992, 116: 743–753.PubMedCrossRefGoogle Scholar
  41. 41.
    Raby KE, Goldman L, Cook EF, Long-term prognosis of myocardial ischemia detected by Holter monitoring in peripheral vascular disease. Am J Cardiol 1990, 66:1309–1313.Google Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Khether E. Raby

There are no affiliations available

Personalised recommendations