What is appropriate coronary assessment prior to abdominal aortic surgery?

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

“…Cardiac complications are estimated to cause more than 40% of peri-operative deaths after non-cardiac surgery 218 and the level of cardiac risk should therefore be assessed clinically. 219 For cases with active cardiovascular disease, such as unstable angina, decompensated heart failure, severe valvular disease, and significant arrhythmia, further specialist assessment and management are required before AAA repair planning.…”

Abdominal Aortic Aneurysm Repair in Octogenarians: Outcomes and Predictors

“…The role of cardiac screening prior to AAA surgery was previously underlined. [25][26][27] Patients at risk of developing cardiac complication have to be identified and the appropriate medical or surgical therapy has to be initiated before AAA surgery. [25][26][27] Age greater than 70 years is a risk factor for cardiac events and for this reason we decided to choose an aggressive policy of cardiac risk assessment for octogenarians, screening with echocardiogram and echo stress test and reserving coronary angiography for patients with abnormalities.…”

Elective Open Operation for Abdominal Aortic Aneurysm in Octogenarians—Survival Analysis of 105 Patients

“…Guidelines have been published on preoperative assessment before major surgery, but no randomised clinical trials (RCT) on the matter have to our knowledge been reported yet. 8 In addition to history, physical examination and ECG, walking together with the patient up stairs is an inexpensive and efficient test of functional capacity, which can easily be done to select patients for further cardiac evaluation. 9 Eight out of 17 patients with preoperative renal failure according to our definition had a postoperative normalisation of serum creatinin values.…”