ABSTRACT
Cardiac complications are among the most common causes of perioperative morbidity and mortality aer vascular surgery (Level 1).1 Studies have shown that such risk is not limited to the perioperative period. As an example, long-term cardiovascular risk has been shown to be greater in patients undergoing intervention for peripheral arterial disease (PAD), abdominal aortic aneurysm (AAA) and carotid artery stenosis than for patients undergoing rst-time coronary angioplasty for coronary artery disease (CAD) (Level 2).2 e reasons for the increased cardiac risk are varied. Major arterial procedures oen involve lengthy anesthetic times and can be associated with substantial hemodynamic stress including uctuations in heart rate, systemic vascular resistance, intraand extravascular uid volume and blood pressure. Due to the similarity of risk factors between PAD and CAD (e.g. diabetes mellitus, dyslipidemia, smoking), patients with PAD inevitably have concomitant CAD. Up to 70% of patients with PAD have been shown to have concomitant CAD which increases the risk of perioperative myocardial ischemia, arrhythmia, congestive heart failure and cardiac death (Level 1).3 Finally, many vascular patients
with severe CAD may not have overt cardiac symptoms due to functionally limiting claudication.
