Abdominal aortic aneurysms and concomitant coronary artery disease. Is routine dipyridamole thallium scintigraphy...

Area of Science:

• Cardiology
• Vascular Surgery
• Diagnostic Imaging

Background:

• High prevalence of coronary artery disease (CAD) in peripheral vascular disease (PVD) patients.
• Cardiac complications are the leading cause of perioperative death after abdominal aortic aneurysm (AAA) repair.
• Risk stratification for perioperative cardiac events is possible through clinical assessment and investigations.

Purpose of the Study:

• To evaluate the utility of dipyridamole thallium scanning (DTS) in identifying myocardial ischemia in PVD patients undergoing AAA repair.
• To determine if identifying and correcting CAD improves perioperative mortality or long-term survival in these patients.

Main Methods:

• Review of dipyridamole thallium scanning (DTS) findings in patients with PVD.
• Analysis of evidence regarding the impact of CAD identification and correction on perioperative outcomes.
• Consideration of risk stratification methods including clinical evaluation, stress testing, and ejection fraction measurement.

Main Results:

• DTS reveals normal scans, reversible defects, or fixed defects in approximately one-third of PVD patients.
• Delayed scans indicate some "fixed" defects are reversible, suggesting myocardial ischemia.
• No evidence supports improved operative mortality or long-term survival from identifying and treating CAD in asymptomatic patients.

Conclusions:

• Routine use of DTS or other cardiac investigations for all PVD patients undergoing AAA repair is not justified.
• While high-risk patients may warrant investigation, optimizing medical treatment may be preferable to revascularization or delaying aneurysm repair.
• The benefit of identifying and correcting CAD in asymptomatic patients undergoing AAA repair remains unproven.