Pre-operative evaluation and risk assessment of patients undergoing vascular surgery

Cardiovascular complications of anaesthesia and surgery remain frequent and have short- and long-term consequences. Identification of high-risk patients is an essential step in the management of patients with cardiovascular disease who are not always fully investigated before admission for non-cardiac surgery. Clinical risk indices allow the risk of complications to be evaluated. However, many indices are inadequate in vascular surgical patients, and there is a need for objective testing of cardiac function and coronary reserve, as poor left ventricular function and reversible ischaemia during stress test are predictors of increased cardiac risk. These tests allow the patientʹs condition to be optimized. This may include coronary bypass surgery. Recently, biological markers of left ventricular dysfunction and of myocardial damage have been introduced. Brain natriuretic peptide concentration is inversely correlated with the ejection fraction, while troponins I and T are very valuable markers of myocardial damage.