Vascular patients are generally older, more likely to smoke, be diabetic and have generalised cardiovascular atherosclerosis. This means they are likely to have accrued an array of co-morbidities related to these.

• Increased age:
  
  
  
  • higher cancer risk elsewhere
    
  • more frail
    
  • chronic kidney disease (CKD)
    
  • polypharmacy
    
  • more complicated social arrangements.
  
  
• Smoking:
  
  
  
  • lung cancer risk
    
  • ischaemic heart disease
    
  • chronic obstructive pulmonary disease (COPD)
  
  
• Diabetes mellitus:
  
  
  
  • increased risk of infection
    
  • visual loss (retinopathy)
    
  • diabetic nephropathy
    
  • neuropathy.
  
  
• Generalised atherosclerosis:
  
  
  
  • ischaemic heart disease
    
  • stroke
    
  • visceral ischaemia.

This latter point is fundamentally important to grasp – if a patient has peripheral vascular disease (PVD), they are very likely to also have coronary arterial disease and carotid artery disease. This means your patient is at higher risk of a MI or stroke perioperatively.

History and Examination

Aside from the usual past medical history etc., be sure to focus spe­cifically on identifying these co-morbidities preoperatively, so for instance:

Cardiac: Do you get chest pain? Do you get shortness of breath (SOB)? Do you get palpitations? Can you walk up two flights of stairs without getting chest pain or SOB (many anaesthetists consider this the most useful question)?

Carotid: Have you ever had a stroke (or TIA)?

Respiratory