Preoperative dipyridamole-thallium scanning, selective coronary revascularization and long-term survival in patients with critical lower limb ischemia.
BACKGROUND
A large proportion of patients with critical limb ischemia have advanced, often asymptomatic coronary artery disease which is associated with increased perioperative risk and decreased long-term survival.


METHODS
We evaluated retrospectively the short and long-term effect of routine dipyridamole-thallium cardiac scanning (DTS) and selective coronary revascularization in 113 consecutive patients who were scheduled for revascularization of the lower extremity.


RESULTS
DTS was abnormal in 60 (53.1%) patients and demonstrated a moderate-severe reversible defect in 26 (23.0%) patients. On the basis of DTS and clinical evaluation 33 (29.2%) patients were referred for coronary catheterization. Of these, 9 underwent PTCA and 4 underwent coronary artery bypass, without complications. Surgical revascularization of the limbs was performed in all but two patients. Two (1.8%) patients died postoperatively, three (2.7%) sustained nonfatal postoperative myocardial infarctions. None of the patients who underwent preoperative coronary revascularization suffered a cardiac complication after the peripheral vascular operation. During mean follow-up of 31.7 months, 30 (28.0%) patients died. A moderate-severe reversible defect on DTS was the strongest predictor for shortened survival (Exp(b)=0.61, CI 95%=0.42-0.88; p=0.006). Patients who underwent preoperative coronary revascularization followed a survival curve approaching those without a reversible defect on DTS (mean survival 61+/-8 vs 63+/-4 months; NS) which was significantly better than those with such a defect who did not undergo coronary revascularization (mean survival 34+/-5 months; p=0.03).


CONCLUSIONS
While the perioperative benefits of routine preoperative DTS screening in patients with critical limb ischemia, remain debatable, it provides an opportunity for identification and treatment of life-limiting coronary artery disease and improving survival.
Wolf
Y G
YG
Department of Vascular Surgery, University Hospital, Jerusalem, Israel.
Landersberg
G
G
Mosseri
M
M
Schechter
D
D
Anner
H
H
Weissman
C
C
Berlatzky
Y
Y
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D004176:Dipyridamole; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007511:Ischemia / Q000150:complications* / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D015999:Multivariate Analysis; D009204:Myocardial Revascularization; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013794:Thallium Radioisotopes / Q000627:therapeutic use*; D014656:Vascular Surgical Procedures
D013794:Thallium Radioisotopes; D004176:Dipyridamole