This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Hao Bui Articles by De Virgilio, C. Search for Related Content PubMed Articles by Hao Bui, Articles by De Virgilio, C. Social Bookmarking                         What's this?

Preoperative Cardiac Evaluation and Interventions Before Aortic Surgery: Are They Justified?

Department of Surgery, Harbor-UCLA Medical Center

Christian De Virgilio, M.D.

UCLA School of Medicine, Harbor-UCLA Medical Center, Division of Vascular Surgery, Torrance, CA

The role of cardiac risk assessment and preoperative cardiac intervention prior to elective vascular surgery remains controversial. In high cardiac risk patients (severe or unstable angina, recent myocardial infarction, decompensated congestive heart failure [CHF]), the risk of an adverse cardiac event is so great that most would agree that these patients should undergo a preoperative cardiac work-up. In most instances strong consideration in these patients should be given to proceeding directly to coronary arteriography In patients with low cardiac risk (those with no active cardiac symptoms, and no Eagle risk factors [angina, age >70 years, history of CHF, Q-wave on EKG, diabetes, ventricular ectopy requiring medication]), the adverse cardiac event rate is so low that one can proceed safely to vascular surgery without any additional cardiac testing. The moderate risk group (patients with one or more Eagle risk factors but without severe or recent cardiac symptoms) may potentially benefit from aggressive cardiac intervention. However, the pendulum appears to be swinging toward less preoperative cardiac evaluation in this group as well. Factors that favor a less aggressive approach even in these moderate risk patients include the lower cardiac morbidity and mortality following aortic surgery observed over the last decade, the lack of a good noninvasive cardiac test that is reproducibly predictive of adverse cardiac events, and the absence of data that demonstrate that subjecting a patient to three invasive procedures (coronary arteriography, coronary revascularization, and peripheral vascular operation) is less morbid than proceeding directly to peripheral vascular surgery.

Key Words: Coronary artery disease • abdominal aortic aneurysm • coronary artery bypass grafting

Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 12, No. 2, 25-41 (2000)
DOI: 10.1177/153100350001200207


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?