KEY POINTS

1. Advances in our understanding of the biology of atherogenesis suggest that endothelial dysfunction is a critical element in the pathogenesis of atherosclerotic cardiovascular disease and its complications. Inflammation in the artery wall probably plays a fundamental role.
2. CAD is the leading cause of perioperative mortality, and long-term survival after vascular surgery is significantly limited by a high incidence of morbid cardiac events.
3. Current guidelines suggest that preoperative coronary intervention is rarely necessary to lower the risk of surgery, unless such intervention is indicated irrespective of the preoperative context.
4. Patients should be maintained on their usual cardiovascular medications throughout the perioperative period.
5. Much of the perioperative risk associated with a prior MI is related to the functional status of the ventricles and the presence of ongoing myocardial ischemia, rather than to the actual age of the infarction.
6. Accurate clinical assessment of the pretest probability of significant CAD is necessary for prudent use and rational interpretation of preoperative cardiac testing.
7. The prevention and treatment of perioperative myocardial ischemia require careful control of the determinants of myocardial oxygen supply and demand.
8. Available evidence suggests the perioperative use of β-blocker therapy can reduce cardiac morbidity and mortality after noncardiac surgery.
9. The clinical usefulness of any intraoperative monitoring technique ultimately depends on patient selection, accurate interpretation of data, and appropriate therapeutic intervention.
10. The perioperative management of patients undergoing vascular surgery requires an understanding of the underlying pathophysiology of the specific vascular lesion.
11. Abdominal aortic aneurysm is a multifactorial disease associated with aortic aging and atherosclerosis.
12. Endovascular aortic surgery has emerged as a less invasive alternative to conventional aortic repair; however, long-term outcome data are lacking.
13. Endoleak, or the inability to obtain or maintain complete exclusion of the aneurysm sac from arterial blood flow, is a complication specific to endovascular aortic repair.
14. The diameter and rate of expansion of abdominal aortic aneurysms are the best predictors of the risk of rupture.
15. The pathophysiology of aortic cross-clamping and unclamping is complex and depends on many factors, including the level of the cross-clamp, the extent of CAD and myocardial dysfunction, the blood volume and distribution, the activation of the sympathetic nervous system, and the anesthetic agents and techniques.
16. The degree of preoperative renal insufficiency is the strongest predictor of postoperative renal dysfunction.
17. Evidence suggests that maintenance of vital organ perfusion and function by the provision of stable perioperative hemodynamics is more important to overall outcome after aortic surgery than the choice of anesthetic agent or technique.
18. The perioperative management of patients undergoing thoracoabdominal aortic aneurysm repair requires a team effort and is probably the most challenging of any surgical procedure.
19. Despite many advances to prevent ischemic injury to the spinal cord, paraplegia remains a devastating complication of thoracoabdominal aortic aneurysm repair.

---

2108

20. Comprehensive guidelines on neuraxial regional anesthesia and anticoagulation are available.^[505]
21. The primary clinical utility of cerebral monitoring during carotid endarterectomy is to identify patients in need of carotid artery shunting; secondarily, such monitoring is used to identify patients who may benefit from blood pressure augmentation or a change in surgical technique.
22. Postoperative hypothermia is associated with many undesirable physiologic effects and may contribute to adverse cardiac outcome.