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Associated vascular lesions in patients undergoing coronary artery bypass grafting
F Cirillo1, A Renzulli, G Leonardo
1Institute of Cardiac Surgery, Second University of Naples, V. Monaldi Hospital, Italy.
Insights
Routine preoperative vascular screening in patients undergoing coronary artery bypass grafting (CABG) reveals high rates of extracoronary atherosclerosis. This screening is crucial for identifying significant carotid and peripheral artery disease, aiding in risk assessment and surgical planning to prevent complications.
Area of Science:
- Vascular Surgery
- Cardiology
- Diagnostic Imaging
Background:
- Extracoronary atherosclerotic disease is common in patients undergoing coronary artery bypass grafting (CABG).
- These lesions can lead to severe postoperative complications and increased mortality.
- Routine preoperative assessment of extracoronary arteries is not standard practice.
Purpose of the Study:
- To determine the prevalence and degree of atherosclerotic lesions in extracoronary arteries (carotid, abdominal aorta, iliac-femoral) in CABG patients.
- To analyze correlations between vascular findings, coronary lesion patterns, and risk factors.
- To evaluate the utility of non-invasive vascular screening in this population.
Main Methods:
- Prospective study of 302 patients undergoing CABG between January and November 1998.
- Routine preoperative echo-Doppler studies of carotid vessels, abdominal aorta, and iliac-femoral arteries.
- Correlation analysis of echo-Doppler findings with coronary angiography and atherosclerotic risk factors.
Main Results:
- 186 patients (61.6%) had carotid disease; 31 (10.2%) had significant stenosis (>70%).
- 20 patients (6.6%) had abdominal aortic dilatation (>25 mm), with 7 >35 mm.
- 165 patients (54.6%) had iliac-femoro-popliteal lesions, with 48 (15.8%) being hemodynamically significant (>70%).
- Significant correlation found between coronary disease severity and both carotid disease (p=0.02) and iliac-femoro-popliteal lesions (p=0.02).
- Symptoms of vascular disease were unreliable predictors of perioperative risk.
Conclusions:
- Atherosclerotic involvement of extracoronary arteries is highly prevalent in CABG patients.
- Non-invasive arterial investigation should be routinely performed preoperatively.
- Comprehensive vascular assessment aids in surgical planning and prevention of perioperative complications.
Abstract:
Atherosclerotic involvement of extracoronary arteries in patients undergoing myocardial revascularization can cause severe postoperative complications and increase postoperative mortality. Between January and November 1998, routine preoperative echo-Doppler study of carotid vessels, abdominal aorta and iliac-femoral arteries was performed in all patients undergoing coronary artery bypass grafting (CABG) at our institution, in order to assess the prevalence and the degree of associated vascular lesions. Correlations between echo-Doppler findings, angiographic patterns of coronary lesions and atherosclerotic risk factors were analyzed in all cases. Among 302 patients undergoing CABG, 186 (61.6%) had carotid disease, with a haemodynamically significant stenosis (>70%) of internal carotid in 31 (10.2%). Twenty-three patients had asymptomatic severe carotid disease. A significant correlation between severity of coronary disease and prevalence of severe carotid disease was found (p = 0.02). An abdominal aortic dilatation (diameter > 25 mm) was found in 20 cases (6.6%), with a diameter >35 mm in 7 patients (2.3%), 6 with triple-vessel coronary disease, and 1 with double-vessel disease. Atherosclerotic lesions of iliac-femoro-popliteal axis were found in 165 (54.6%) patients, with a strong correlation to the severity of coronary disease (p = 0.02); lesions were haemodynamically significant (> 70%) in 48 (15.8%) cases. Symptoms of carotid and peripheral vascular disease are no reliable predictors of perioperative risk in patients undergoing CABG. Non-invasive complete arterial investigation should be routinely performed in these patients, in order to plan the most suitable operative approach and to prevent perioperative vascular complications.