Prevention of cardiac complications in peripheral vascular surgery
The prevalence of severe coronary artery disease in peripheral vascular patients exceeds 50 per cent. Complications of coronary artery disease are the most common causes of mortality following peripheral vascular operations. To reduce the incidence of cardiac complications, it is first necessary to identify patients at risk through screening tests. Screening methods in current use include risk factor analysis, exercise testing, routine coronary angiography, and dipyridamole thallium-201 scintigraphy. The risk factor approach has the advantage of being widely applicable since it makes use of historical, physical, and electrocardiographic findings that are already familiar to surgeons and anesthesiologists. It is also inexpensive. However, it may overlook the patient who has no symptoms of coronary artery disease, possibly as a result of the sedentary lifestyle imposed by complications of peripheral vascular disease. The electrocardiographically monitored stress test will identify the asymptomatic patient with occult coronary disease and is helpful in predicting operative risk. However, a meaningful test is dependent on the patient's ability to exercise--an activity that is frequently limited by claudication, amputation, or arthritis. Exercise testing also suffers from a lack of sensitivity and specificity when compared with coronary arteriography. Routine preoperative coronary angiography overcomes the exercise limitation of treadmill testing but is not widely applicable as a screening test for reasons of cost and inherent risk. Dipyridamole thallium-201 scanning, on the other hand, is safe and of relatively low cost and does not require exercise.
- Research Organization:
- Univ. of Massachusetts Medical Center, Worcester
- OSTI ID:
- 5530951
- Journal Information:
- Surg. Clin. North Am.; (United States), Journal Name: Surg. Clin. North Am.; (United States) Vol. 2; ISSN SCNAA
- Country of Publication:
- United States
- Language:
- English
Similar Records
Failure of dipyridamole-thallium myocardial imaging to detect severe coronary disease
Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery
Related Subjects
62 RADIOLOGY AND NUCLEAR MEDICINE
ARTERIES
BETA DECAY RADIOISOTOPES
BIOMEDICAL RADIOGRAPHY
BLOOD VESSELS
BODY
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
CORONARIES
COUNTING TECHNIQUES
DAYS LIVING RADIOISOTOPES
DIAGNOSIS
DIAGNOSTIC TECHNIQUES
DISEASES
ELECTRON CAPTURE RADIOISOTOPES
EXERCISE
HEAVY NUCLEI
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
MEDICINE
MYOCARDIAL INFARCTION
NUCLEAR MEDICINE
NUCLEI
ODD-EVEN NUCLEI
ORGANS
PATIENTS
RADIOISOTOPE SCANNING
RADIOISOTOPES
RADIOLOGY
RISK ASSESSMENT
SCINTISCANNING
SECONDS LIVING RADIOISOTOPES
THALLIUM 201
THALLIUM ISOTOPES
VASCULAR DISEASES