To the Editor.
—In the May Archives, Hertzer et al1 suggested an algorithm to be employed in the preoperative evaluation of patients being considered for peripheral vascular reconstruction.One cannot quibble with the overall intent of their article, which was to emphasize once again the need for careful preoperative cardiac evaluation in this group of patients in whom the prevalence of significant coronary disease is so great.I believe that Hertzer et al, however, overlooked an important new method to be used in the detection of clinically significant coronary disease. Boucher et al2 recently reported on the utility of dipyridamole-thallium imaging prior to peripheral vascular surgery, finding this technique to be highly predictive of the need for preoperative coronary angiography and revascularization if possible. While dipyridamole-thallium imaging will remain an investigational procedure in the short term, I believe that it will become the single most important preoperative predictor
Held AC. Dipyridamole-Thallium Imaging. Arch Intern Med. 1985;145(10):1927. doi:10.1001/archinte.1985.00360100201042