Nationwide German Survey on Cardiac Management in Vascular Surgery
Overview
A nationwide survey in Germany revealed variability in perioperative cardiac management practices for vascular surgery patients. Most centers perform preoperative cardiac evaluations before open abdominal aortic surgery, but less so for other vascular procedures. Postoperative monitoring durations and use of cardiac biomarkers also varied widely.
Background
Perioperative myocardial ischemia is a significant complication following vascular surgery, necessitating thorough cardiac risk stratification. High-risk vascular surgery patients, especially those undergoing open aortic surgery, require careful preoperative assessment to identify and optimize cardiac conditions. Despite existing general guidelines for cardiac risk stratification before non-cardiac surgery, specific recommendations for vascular surgery patients remain lacking. This survey aimed to evaluate current perioperative cardiac management practices across German vascular surgery centers.
Data Highlights
Parameter
Percentage of Respondents
Preoperative cardiac evaluation before open abdominal aortic surgery
87%
Preoperative cardiac evaluation before vascular surgery (carotid, peripheral, EVAR)
42%
Preoperative cardiac evaluation before peripheral intervention
12%
Use of acetylsalicylic acid preoperatively
79%
Use of statins preoperatively
68%
Use of β-blockers preoperatively
30%
Routine postoperative ICU monitoring after open abdominal aortic surgery (24 h)
38%
Routine postoperative ICU monitoring after EVAR (24 h)
45%
Routine postoperative ICU monitoring after peripheral arterial surgery (none)
48%
Routine postoperative ICU monitoring after peripheral intervention (none)
89%
Routine postoperative troponin testing after open abdominal aortic surgery
19%
Routine postoperative troponin testing after vascular surgery
6%
Key Findings
87% of centers routinely perform preoperative cardiac evaluations before open abdominal aortic surgery, but only 42% before other vascular surgeries and 12% before peripheral interventions.
Cardiac echography is included in 92% of preoperative cardiac evaluations, while stress diagnostics are used in 38%.
Routine preoperative cardiac catheterization is rare, performed by 4% before open abdominal aortic surgery and 0.5% before other vascular surgeries.
Postoperative ICU monitoring duration after open abdominal aortic surgery varies, with 38% monitoring for 24 hours and 37.5% for 24–48 hours.
After EVAR, 45% of centers monitor patients in ICU for 24 hours, whereas nearly half do not monitor after peripheral arterial surgery and 89% do not monitor after peripheral interventions.
Routine postoperative serum troponin testing in asymptomatic patients is uncommon, used by 19% after open abdominal aortic surgery and 6% after other vascular surgeries.
Clinical Implications
The survey highlights heterogeneity in cardiac risk assessment and postoperative monitoring practices for vascular surgery patients in Germany. Clinicians should consider standardized protocols for preoperative cardiac evaluation, especially for high-risk procedures like open abdominal aortic surgery. Postoperative monitoring strategies and biomarker use may benefit from clearer guidelines to optimize patient outcomes and resource utilization.
Conclusion
Cardiac risk stratification and perioperative management in vascular surgery remain individualized due to the absence of specific guidelines. This nationwide survey underscores the need for consensus recommendations to harmonize care and improve cardiovascular outcomes in this high-risk population.
References
German Nationwide Survey 2018 -- Findings from a Nationwide German Survey on Cardiac Management During Vascular Surgical Procedures
