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KMID : 0357019960120020197
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Journal of the Korean Vascular Surgery Society
1996 Volume.12 No. 2 p.197 ~ p.203
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Preoperative Cardiac Evaluation in Patients with Aortoiliac Occlusive Disease
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Abstract
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Several risk stratification models have been suggested to isolate high risk groups, for cardiac morbidity in ASO patients undergoing peripheral vascular procedures. This is of special importance in patients with aortoiliac occlusive disease(AOD),
who
require aortic cross-clamping. To assess the efficacy and the clinical implication of different cardiac evaluation modalities in AOD patients, a retrospective study was carried out. Medical records of 75 AOD patients (M : F=72 :3) undergoing
aortoiliac
surgery from February 1991 to December 1995 were reviewed for clinical risk factors(CR) -old age(>70), history of diabetes, acute myocardial infarction, congestive heart failure and chest pain, for cardiac evaluation studies and for operative
outcome.
Average age of the patients was 60±8.4 years. Aortobifemoral bypass was the majority of the operation performed(n=85) and 4 patients who had coronary revascularization (1 CABG and 3 PTCA) preoperatively were included in this group. Other high
risk
patients (n=7) were recommended femoral-femoral crossover bypass with or without balloon angioplasty and stent insertion. In the remaining 10 patients, 6 ilio-infrainguinal bypasses and 4 other lesser procedures were done as the operation of
choice.
Cardiac evaluations in the study population included resting EKG in all patients, Dipyridamole-stressed 99mSestamibi-SPECT (MIBI) in 26, resting echocardiography (ECO) in 41 and coronary angiography (CAG) in 48. Six cardiac complications occurred
in 6
patients (8.0%); 3 acute myocardial infarctions, and 3 severe dysrhythmias. There was no postoperative cardiac mortality. The absence of any CR yielded 100% negative predictive value forcardiac complications, with 100% sensitivity. Both EKG and
ECO
were
not of great contribution in detecting overt coronary involvement nor in predicting morbidity. MIBI and CAG was both 100% sensitive and 100% negative predictive for cardiac morbidity. The morbidity of CAG positive patients was higher than test
negative
patients with statistical significance (p=0.029). Other modalities didn't reach statistical significance. However, the superiority of CAG cannot be made certain due to the retrospective nature of this study. We coclude that identifying non-risk
group by
CR is of primal importance in preoperative cardiac evaluation for AOD patients since one can minimize unnecessary further studies. But subsequent cardiac evaluation modality of choice in risk population awaits future randomized prospective trial
results.
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KEYWORD
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