Algorithm of preoperative cardiovascular diagnostics before vascular surgery

Patients with multimorbidities are increasingly being treated by surgery/vascular surgery. A guideline on perioperative management prior to non-cardiac surgery was published by the European Society of Cardiology in 2022. The recommendations, with a focus on vascular surgery patients, are summarised here. The individual patient and surgical risk should be evaluated preoperatively. Based on these factors, a corresponding risk assessment is carried out and the patients undergo a diagnostic algorithm. A new recommendation is to screen cardiac biomarkers before medium- and high-risk operations in patients aged 65 or over, or with specific cardiovascular risk factors or diseases. Therefore, perioperative myocardial damage is diagnosed early in a high-risk population. The appropriate therapy should reduce perioperative mortality. In vascular surgery in particular, patients with underlying atherosclerotic disease represent major challenges for perioperative therapy and diagnostics.