Clinical Assessment
Applied
Type
AdditionConfidence
90%
Created
Mar 27, 2026
Evidence
3 sources
Rationale
The integration adds high-quality evidence from recent guidelines and systematic reviews. The 2025 ACC statement provides specific clinical assessment requirements for the diabetic population, which is a critical subset of vascular patients. The systematic review by Lyons et al. validates the anatomic scoring systems (like GLASS) used in the PLAN framework already mentioned in the text. Finally, the SMART2-HF model adds a valuable long-term risk assessment tool for heart failure in ASCVD patients, complementing the perioperative focus of the RCRI. All abbreviations (DM, HF, ASCVD) were expanded on first use as per instructions.
Evidence
Content Changes
removedadded
History of claudication, rest pain, ulceration, or embolic events is essential. In patients with diabetes mellitus (DM), a comprehensive foot examination including assessment for sensory loss and skin integrity is mandatory to identify those at highest risk for complications [@acc2025-d]. On examination: * **Arterial:** pulse deficit, bruits, trophic skin changes. * **Venous:** varicosities, edema, skin pigmentation, ulceration. * **Lymphatic:** swelling, non-pitting edema, skin thickening. For peripheral arterial disease (PAD), risk-stratify limb threat with Wound, Ischemia, and foot Infection (WIfI) staging (wound, ischemia, infection) and integrate with patient risk and anatomy (PLAN) to guide revascularization strategy [@conte2019-gvg]. Angiographic scoring systems utilized within these frameworks are significantly associated with clinical outcomes, including limb salvage and patency [@lyons2026-b]. ### Perioperative Cardiac Risk Assessment Vascular surgery patients have high rates of coronary artery disease. The Revised Cardiac Risk Index (RCRI) helps stratify perioperative major adverse cardiac events (MACE) risk before non-cardiac surgery [@lee1999]. Vascular procedures (especially aortic and lower extremity) are classified as high-risk surgery, contributing 1 point to the RCRI score. Beyond the perioperative period, the SMART2-HF model can be utilized to predict the long-term risk of incident heart failure (HF) in patients with established atherosclerotic cardiovascular disease (ASCVD) [@reitsma2026-b]. :::widget{type="calculator" id="rcri"} {} :::