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The Journal of Cardiovascular Surgery 2001 February;42(1):89-95

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Preoperative dipyridamole-thallium scanning, selective coronary revascularization and long-term survival in patients with critical lower limb ischemia

Wolf Y. G., Landersberg G. *, Mosseri M. **, Schechter D. **/***, Anner H., Weissman C. *, Berlatzky Y.

From the Department of Vascular Surgery *Anesthesiology, **Cardiology and ***Nuclear Medicine Hadassah University Hospital, Jerusalem, Israel


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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(β)=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.

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