Perioperative Management of Cardiovascular Risk in Vascular Surgery Patients: WhatÃ¢ÂÂs New in 2014?
Jennifer B Cowart*, Jeffrey T Bates and Addison A Taylor
Michael E DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA
- *Corresponding Author:
- Jennifer B Cowart
Michael E. DeBakey VA Medical Center
Baylor College of Medicine
Houston, Texas, USA
E-mail: [email protected]
Received Date: November 19, 2014; Accepted Date: November 29, 2014; Published Date: December 01, 2014
Citation: Cowart JB, Bates JT, Taylor AA (2014) Perioperative Management of Cardiovascular Risk in Vascular Surgery Patients: What’s New in 2014?. J Vasc Med Surg 2:168. doi: 10.4172/2329-6925.1000168
Copyright: © 2014 Cowart JB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Preoperative Cardiovascular (CV) risk stratification and management of medical comorbidities have undergone major changes in the past two decades. Two new risk stratification tools have been developed and validated to complement the Revised Cardiac Risk Index (RCRI) originally implemented in 1999. Since these tools have not yet been compared, the most recent guidelines merely recommend that one of these validated tools be used when risk stratifying patients preoperatively. The most recent guidelines for perioperative medical management of patients undergoing non-cardiac surgery have placed less emphasis on use of beta-blockers and more emphasis on the potential benefits of HMG-CoA reductase inhibitors, or statins, as studies have emerged reporting reductions in perioperative atrial fibrillation, impairment of renal function and in the rate of growth of abdominal aortic aneurysms. The guidelines also emphasize the importance of antiplatelet therapy but do not comment on smoking cessation, interventions which are often underutilized. This review will focus on strategies for CV risk reduction in vascular surgery patients, both perioperatively and long term.