Assessment of cardiac risk before vascular surgery by dipyridamole thallium testing

Morbidity and mortality related to coronary artery disease (CAD) is a significant problem during the perioperative phase of major noncardiac vascular surgery, i, 2 because of the high incidence of severe CAD in this particular population. 3 Routine coronary angiography prior to major vascular surgery, advocated by some authors, 3 is expensive, while the coronary anatomy does not accurately predict the extent of jeopardised myocardium in many cases. Moreover, performing coronary angiography in patients with severe peripheral vascular disease is characterised by a significantly higher rate of vascular complications. Therefore, there is a need for a non-invasive assessment of CAD in patients selected for major vascular surgery, in order to identify high risk patients, who are subsequently referred for coronary angiography and coronary revascularisation. Most of the non-invasive tests use maximal physical exercise with concurrent increases in myocardial oxygen demand and in coronary b lood flow. The presence of CAD can be detected by electrocardiographic changes, reflecting myocardial ischaemia, or by abnormal patterns of left ventricular perfusion and wall motion shown by scintigraphic techniques.