[Estimation of perioperative cardiac risk by means of dipyridamole myocardial scintigraphy in patients undergoing vascular surgery on the lower limbs].
The vascular surgery of lower limbs has an increased cardiac risk that is related to the special surgical procedure and the high risk patient population. The myocardium scintigraphy after the administration of dipyridamole is a reliable stress testing, even despite claudication complaints. The authors performed dipyridamole stressed quantitative MIBI scintigraphy in 35 patients with peripheral arterial disease for the assessment of prognostic importance of the test. Twenty seven of the 29 patients (92%) referred for vascular surgery had a positive scintigram. In the two thirds of abnormal investigations (18 patients) there had been rest perfusion defects too, despite the fact that only one patient had a positive history regarding myocardial infarct (MI). Six cardiac complications occurred; all in the aorta crossclamping group (6/21, 29%): 5 nonfatal postoperative MI (4 of them were silent) and 1 patient died. All of the complicated cases showed positive preoperative scintigraphy but only 2 of them had stress induced perfusion defect; 4 patients presented fixed defects.


CONCLUSIONS
1. Especially the operations necessitating the cross-clamping of aorta are harmful. 2. Cardiac complications are frequently atypical in their clinical appearance. Thus, 24 and 48 hour after the vascular surgery ECG an enzyme investigations are indicated. 3. The fixed MIBI defects that can also be found at rest, have significant implications. 4. The most effective cardiac risk stratification before vascular surgery is a complex approach in which the clinical, ECG and imaging data are incorporated.
Antalffy
J
J
Debreceni Orvostudományi Egyetem I., Sebészeti Klinika.
Bajnok
L
L
Kozlovszky
B
B
Varga
J
J
Olvasztó
S
S
Fülöp
T
T
D000328:Adult; D000368:Aged; D001162:Arteriosclerosis Obliterans / Q000601:surgery*; D004176:Dipyridamole; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D011877:Radionuclide Imaging; D012307:Risk Factors; D017256:Technetium Tc 99m Sestamibi
D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi
Alsó végtagi érmütétre kerülö betegek perioperatív kardiális kockázatának felmérése dipyridamol myocardium szcintigráfiával.