VASCULAR SURGERY AND PERIPHERAL ARTERIAL DISEASES IN PATIENTS WITH HEART DISEASE

Abstract

Introduction: Vascular surgery in patients with cardiac and peripheral arterial diseases represents a significant clinical challenge. The coexistence of these conditions increases the complexity of treatment and the risk of complications. Peripheral arterial disease (PAD), characterized by the narrowing or obstruction of the arteries supplying the lower limbs, frequently coexists with coronary, cerebrovascular and other cardiovascular diseases. The interaction between these diseases and the impact of vascular surgery on cardiac function are crucial issues to be explored. Objective: The objective of this systematic literature review was to synthesize the available scientific evidence on the relationship between vascular surgery, peripheral arterial diseases and cardiac diseases. We sought to identify the main risk factors, the most common complications, the treatment strategies and the clinical outcomes in patients undergoing vascular procedures. Methodology: The review followed the PRISMA guidelines and included articles published in the last 10 years in the PubMed, Scielo and Web of Science databases. The following descriptors were used: "vascular surgery", "peripheral arterial disease", "heart disease", "co-morbidities" and "clinical outcomes". The selection of studies included original articles in Portuguese and English, which evaluated adult patients undergoing vascular procedures for the treatment of PAD, with or without cardiac comorbidities. Case studies, narrative reviews and studies with inadequate methodological design were excluded. Results: Fifteen studies were selected. Analysis of the included studies revealed that the coexistence of heart disease and PAD significantly increases the risk of postoperative complications, such as myocardial infarction, heart failure and stroke. Rigorous preoperative evaluation, including optimization of heart disease control, is essential to minimize these risks. The choice of surgical procedure and anesthetic technique should be individualized, considering the clinical characteristics of each patient. The long-term results of vascular surgery in patients with cardiac comorbidities are variable and depend on several factors, such as the extent of the disease, the presence of other risk factors, and the quality of postoperative follow-up. Conclusion: Vascular surgery in patients with cardiac and peripheral arterial diseases represents a complex clinical challenge. The coexistence of these conditions increases postoperative morbidity and mortality. Optimization of preoperative medical treatment, appropriate choice of surgical procedure, and multidisciplinary follow-up are essential to improve clinical outcomes. Future studies are needed to identify new therapeutic strategies and prognostic markers that can aid clinical decision-making.