PREOPERATIVE EVALUATION

Coexisting Disease

Patients having peripheral vascular surgery are a select group with a high incidence of coexisting disease (see Chapter 27 ) associated with advanced age, cigarette smoking, diabetes mellitus, and hypertension, all of which should be assessed and, if possible, optimized before surgery (see Chapter 24 ). It is also well recognized that CAD is the leading cause of perioperative mortality at the time of peripheral vascular surgery and that long-term survival after vascular procedures is significantly limited by a high incidence of morbid cardiac events. ^[26] Given the systemic nature of atherosclerotic disease, less than 10% of patients who present for vascular surgery have normal coronary arteries, and more than 50% of patients have advanced or severe CAD.^[27] The preoperative period presents an opportunity to optimize pharmacologic management, perform diagnostic and therapeutic interventions, and adjust care to decrease perioperative risk and the long-term risks from cardiovascular events.