Regarding Peri operative Evaluation....

You are asked to perform a preoperative evaluation on a 55-year-old white woman with type 2 diabetes mellitus prior to elective femoral– anterior tibial artery bypass surgery. She is unable to climb a flight of stairs or do heavy work around the house. She denies exertional chest pain and is
otherwise healthy. Based on current guidelines, which one of the following diagnostic studies would be appropriate prior to surgery because the results could alter the management of this patient?
A) Pulmonary function studies
B) Coronary angiography
C) Carotid angiography
D) A dipyridamole-thallium scan
E) A hemoglobin A1c level

Answer and Discussion
The answer is
D.  A dipyridamole-thallium scan

A preoperative evaluation prior to noncardiac surgery requires an assessment of the perioperative cardiovascular risk of the procedure involved, the functional status of the patient, and clinical factors
that can increase the risk, such as diabetes mellitus, stroke, renal insufficiency, compensated or prior heart failure, mild angina, or previous myocardial infarction (MI). This patient is not undergoing emergency surgery, nor does she have an active cardiac condition; however, she is undergoing a high-risk procedure (>5% risk of perioperative MI) with vascular surgery. As she cannot climb a flight of stairs or do heavy housework, her functional status is <4 METs, and she should be considered
for further evaluation. The patient’s diabetes is an additional clinical risk factor. With vascular surgery being planned, appropriate recommendations include proceeding with the surgery with heart rate control, or performing noninvasive testing if it will change the management of the patient.
Coronary angiography is indicated if the noninvasive testing is abnormal.
Pulmonary function studies are most useful in patients with underlying lung disease or those undergoing pulmonary resection.
Hemoglobin A1c is a measure of long-term diabetic control and is not particularly useful perioperatively.
Carotid angiography is not indicated in asymptomatic patients being considered for lower-extremity vascular procedures.