Indications for myocardial revascularization before endovascular aortic repair

Due to the strong relationship between abdominal aortic aneurysm (AAA) and coronary morbidity and mortality, it seems mandatory to spend some more time investigating about coronary risk of our endovascular aortic repair (EVAR) patients. Physical examination, basic laboratory testing and ECG will allow us to determine whether the surgical risk for a patient is low, moderate or high. In general a patient who is at low risk will not need any further evaluation. Those at who are at high risk usually will undergo coronary angiography. Patients who are at intermediate risk, probably the largest subgroup of patients candidate to EVAR, will often need additional testing like assessment of resting left ventricular function, exercise stress testing, pharmacological stress testing, ambulatory ECG monitoring, and coronary angiography as well as exercise echocardiography or exercise myocardial perfusion imaging should be considered. Patients undergoing an EVAR procedure, who are found to have prognostic high-risk coronary anatomy and in whom long-term outcome would likely be improved by coronary revascularization, should generally undergo revascularization first. In conclusion, we recommend to evaluate the cardiac status of EVAR's patients in order to reduce the most common serious morbidity related to this new therapeutic modality.