Assessment and reduction of perioperative risk in vascular patients

Authors - Drs Mike Swart and Simon Howell

Date published - 21 September 2011

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Magnitude of risk in vascular surgery

  • An understanding of the mortality and morbidity risk for both undergoing and not undergoing vascular surgery
  • Risks and benefits of the different surgical options, for example EVAR versus open AAA surgery or carotid endarterectomy versus stenting for carotid artery occlusion.

Assessment of risk and commonly used risk scoring systems

  • An ability to identify the risk factors by history examination and investigation.
  • Including RCRI/CPI/POSSUM

Preoperative Testing

  • Interpretation of static cardiac tests ECG, Echocardiography, Cardiac MRI. Respiratory tests which tests?
  • Role of stress testing: Exercise ECG, Dobutamine stress Echo, MUGA scan , CPET
  • Interpretation, integration and communication of test results

Interventions

  • Role and place of cardiac intervention
  • Current evidence for statins, beta-blocker and anti-platelet agent use
  • Incentive spirometry?

Quality improvement initiatives and Audit

  • VASCUNET
  • QIP

Guidelines

  • ESC and ACC/AHA guidelines others

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