Anesthetic management of vascular surgery is highly demanding, due to physiologic perturbations caused by major vascular procedures, as well as the high burden of existing atherosclerotic disease or disease equivalents that are often poorly controlled in this patient population. The perioperative care of the vascular patient is often complex, requiring a thorough preoperative evaluation, sophisticated intraoperative management, and attentive postoperative care. Of paramount importance to the anesthesiologist is the likelihood of major adverse cardiac events (MACEs), the incidence of which may be mitigated by appropriate risk stratification and a detailed understanding of specific major vascular surgical procedures.