Reviews and Notes: Cardiology: Cardiac Risk Assessment before Vascular Surgery

Cardiac Risk Assessment before Vascular Surgery

Andris Kazmers; ed. 364 pages. Armonk, New York: Futura; 1994. $52.00.

Internists and cardiologists are frequently called on to evaluate patients having widely various types of vascular surgery, including abdominal aortic aneurysm repair, peripheral arterial bypass, amputation, and carotid endarterectomy. Patient outcome depends on the presence and severity of coexisting cardiac disease. As a clinician, a critical question that arises is, What are the best tests with which to evaluate these patients? This important question has many corollary questions: What is the best noninvasive test to do? What is a reasonable and cost-effective algorithm for risk stratification? Should all patients have preoperative cardiac catheterization? Does preoperative bypass surgery have a role in patients with concomitant coronary artery disease?

This book covers almost every facet of risk assessment for patients having vascular surgery. It includes chapters on natural history, outcome after vascular surgery, exercise testing (including radionuclide and echocardiographic techniques), considerations in anesthesia, and the role of coronary arteriography and prophylactic bypass surgery in patient management. The book is scholarly and comprehensive and has numerous references from 1992 or later.

The editor has allowed a substantial amount of overlap between some chapters; the authors present their own strategies for patient evaluation and risk assessment. This is helpful because it provides a distillation of conflicting studies and allows the reader to see how different experienced clinicians might handle these complex evaluations. The final chapter contains the editor's "state-of-the-art" overview of the most important patient management issues, including his own management strategy. Finally, the casual reader must understand that this is a comprehensive review of the anesthetic, general, and cardiac risk assessment necessary in patients having vascular surgery. Vascular surgeons and cardiologists responsible for preoperative assessment in such patients will find this book an invaluable reference. On the other hand, internists and cardiologists with only a passing interest in this field will probably prefer to read one of the many recent reviews on this subject (or the final chapter of this textbook). The final word is not in! Reports arguing the merits of different risk stratification algorithms for patient management in this evolving field continue to be published.