Background: Vascular surgery is a high operative risk because of high prevalence of cardiovascular disease in patients with vascular disease. Recently developed cardiac computed tomography provides excellent image of coronary artery disease and myocardial perfusion image using adenosine stress. We investigated the role of 128 dual source computed tomography (DSCT) in preoperative risk evaluation of vascular surgery. Methods: Patients who were scheduled for vascular surgery were enrolled and performed DSCT with adenosine stress before surgery. Patients who had unstable angina, recent myocardial infarction, decompensated heart failure, or renal failure were excluded. Any contraindications for CT or adenosine were also excluded. Stress perfusion CT was first acquired using sequence mode during adenosine infusion, and scanning for CT angiography was followed by helical mode using 128-slice dual source CT. CT image was analyzed by 2 independent readers. Additional test for preoperative risk after DSCT totally depends on attending physician���s decision. Results: Ninety five patients were performed adenosine stress DSCT. Among them, 4 patients were failed to complete the stress perfusion because of low heart rate or poor operation during adenosine stress. Mean radiation dose (total dose length product) was 943.7 짹 471.5 mGycm. Eighty six patients (94.5%) had coronary atherosclerosis and 36 patients (39.6%) had more than 50% of coronary artery stenosis. Perfusion defect with significant stenosis was found in 8 cases (8.8%). Additional invasive coronary angiography before vascular surgery performed in two patients but there was no revascularization. Six patients (6.6%) had cardiovascular events in perioperative periods; two of embolic events, two of arrhythmia, one of cardiac arrest, and one of decompensated heart failure. Most of the cardiovascular events happened in patients with intermediate lesion. Conclusions: We cannot conclude that DSCT has any important role in preoperative risk evaluation in this study because the number of events was very small, but coronary atherosclerosis and significant coronary artery stenosis was very commonly found in DSCT in patients scheduled for vascular surgery. Pperfusion defect with significant lesion was only small proportion of the patients and it did not eventually lead to perioperative myocardial infarction or heart failure.