Background Myocardial injury after non-cardiac surgery (MINS) is often clinically silent but associated with increased mortality, supporting routine troponin surveillance in high-risk patients. The VISION study defined MINS using high-sensitivity troponin T (hsTnT). Vascular surgery patients were underrepresented in this study, so it is unclear whether the VISION definition applies to these patients. Thus, we aimed to evaluate how well this definition identifies myocardial injury in vascular surgery patients. Methods This prospective observational cohort study recruited 77 vascular surgery patients at Wellington Regional Hospital. hsTnT was measured preoperatively and on postoperative day 1 (POD1). MINS was defined per the VISION study as either: (1) a postoperative hsTnT >65ng/L or (2) 20-65ng/L with a rise >=5ng/L from the preoperative value. Patients who met these definitions were flagged for clinical review. Results The median age of the cohort was 71 years; 86% were male and 79% had an ASA classification of >=III. The median preoperative and POD1 hsTnT values were 15 ng/L (IQR 16) and 17 ng/L (IQR 15) respectively. Sixteen patients (21%) met the MINS definition. Of these, 8 met definition (1), 4 of whom had chronic elevation (<20% change at POD1). For those remaining, elevation was attributed to non-ischaemic causes (n=1), myocardial infarction (n=1) or unexplained (n=2). Of the 8 patients who met definition (2), 1 had chronic elevation. The other patients had a median increase of 31% (IQR 20) at POD1, attributed to non-ischaemic causes (n=4) or unexplained (n=3). Conclusion The VISION definition identified 21% of vascular surgery patients with potential postoperative myocardial injury at POD1. Most cases were attributable to non-ischaemic causes, highlight the complexity of troponin interpretation in this cohort. Preoperative hsTnT differentiated chronic and acute troponin elevation, which may support targeting unexplained POD1 elevations for further investigation.