The recognition that atherosclerosis is a systemic process means that the fields of cardiology and vascular surgery frequently overlap. The cardiologist should have an understanding of the recent developments in the treatment of carotid artery disease, aortic aneurysms, and chronic limb ischaemia. Similarly, the vascular surgeon should recognise the incidence of coronary artery disease in their patients presenting with peripheral vascular disease and the need for cardiological assessment. The cooperation between the two specialties is being accelerated by the rapid development of endoluminal and minimally invasive techniques in each field.

PERIOPERATIVE CARE IN VASCULAR SURGERY

Enthusiasm for vascular surgery have always been tempered by the rate of perioperative morbidity and mortality resulting from the nature of the surgery and the co-morbidity of the patient. In many institutions, patients undergoing major vascular surgery are managed in general surgical wards. In this setting, there may be poor recognition among nursing and medical staff that these patients are at greater risk than general surgical patients because of the very high prevalence of significant, yet often occult, coronary artery disease. The development of vascular surgery as a subspecialty and the growth of specialised vascular units address this problem but will place increasing demands on the local cardiology services.

The most common cause of postoperative death after vascular surgery is myocardial infarction. Appropriate preoperative assessment can be problematic as nearly half of all vascular operations are urgent or emergency procedures. There has been controversy about how much preoperative investigation and intervention for coronary artery disease is of proven benefit in patients undergoing major vascular surgery. Most work has concentrated on surgery for abdominal aortic aneurysm since it is one of the most common vascular surgical procedures and stresses the heart, with increased afterload during aortic cross-clamping and blood loss. There is good evidence that if a patient has no previous …