From the Guidelines
For a femoral to femoral graft, the key cardiology pre-op requirements typically include comprehensive cardiac evaluation, optimization of cardiovascular medications, antiplatelet management, and assessment of other cardiovascular risk factors, as outlined in the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery 1.
Cardiac Evaluation
- Detailed medical history and physical examination
- 12-lead ECG
- Transthoracic echocardiogram
- Stress test (exercise or pharmacological) if the patient can tolerate it
Optimization of Cardiovascular Medications
- Continue beta-blockers if already prescribed (e.g., metoprolol 25-100 mg twice daily)
- Consider starting beta-blockers in high-risk patients (start at least 2-7 days before surgery)
- Continue statins (e.g., atorvastatin 40-80 mg daily)
- Adjust antihypertensive medications to maintain blood pressure <140/90 mmHg
Antiplatelet Management
- Continue aspirin (81-325 mg daily) perioperatively if already prescribed
- Hold clopidogrel for 5-7 days before surgery, if possible
Assessment of Other Cardiovascular Risk Factors
- Optimize diabetes control (target HbA1c <7%)
- Smoking cessation counseling These requirements aim to assess cardiac risk, optimize cardiac function, and reduce perioperative complications, as supported by the guidelines and studies on peripheral arterial disease management 1. The cardiac evaluation helps identify any underlying cardiac conditions that may increase surgical risk, while medication management and antiplatelet therapy can reduce the risk of perioperative cardiac events. Addressing modifiable risk factors like diabetes and smoking can further improve outcomes. It is not recommended to perform routine coronary revascularization before noncardiac surgery exclusively to reduce perioperative cardiac events, unless the patient has unstable coronary artery disease or other indications for revascularization 1.
From the Research
Pre-Operative Requirements for Femoral to Femoral (Arteriovenous) Graft
- The pre-operative requirements for a femoral to femoral (arteriovenous) graft are not explicitly stated in the provided studies, but some relevant information can be inferred from the texts.
- According to 2, a preoperative percutaneous transluminal angioplasty was performed in 25% of patients to correct donor iliac artery disease, suggesting that vascular evaluation and potential intervention may be necessary before the procedure.
- The study 3 mentions that noninvasive evaluation in the vascular laboratory can assist in the preoperative selection of patients and determine if the iliac artery on the asymptomatic side is capable of acting as an inflow vessel.
- In terms of cardiology pre-operative requirements, the study 4 discusses the importance of considering the type of vascular access in patients with prior coronary artery bypass grafting, but it does not provide specific guidelines for femoral to femoral grafts.
- The study 5 analyzes the use of antithrombotic therapy in patients with extra-anatomic bypass grafts, including femoral-femoral bypass, but it does not provide information on pre-operative cardiology requirements.
- The study 6 describes a case of TandemHeart insertion via a femoral arterial GORE-TEX graft conduit in a high-risk patient, but it does not provide general pre-operative requirements for femoral to femoral grafts.
Relevant Factors to Consider
- Vascular evaluation and potential intervention, such as percutaneous transluminal angioplasty, may be necessary before the procedure 2.
- Noninvasive evaluation in the vascular laboratory can assist in the preoperative selection of patients and determine if the iliac artery on the asymptomatic side is capable of acting as an inflow vessel 3.
- The type of vascular access and antithrombotic therapy may be important considerations in patients with prior coronary artery bypass grafting or other comorbidities 5, 4.