<p>Vascular surgery patients are often multimorbid, older and therefore predisposed to polypharmacy, which can increase the risk of drug-related problems. Meticulous medication analysis is particularly crucial in older patients in order to avoid overtreatment while ensuring treatment that improves the prognosis. In addition, organ function can be impaired by additional factors in the perioperative setting. These can necessitate dose adjustments or increase the risk of interactions due to indicated new drugs. Structured medication management, supported by validated screening tools, helps to identify and adjust potentially inappropriate medications. This article aims to provide practical recommendations for optimizing treatment and guidance on how to make medication in vascular surgery safe and effective.</p>