Concomitant coronary and peripheral arterial disease: single-stage revascularization

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Anesthesiology

Background:

• Managing patients with concurrent critical peripheral arterial ischemia and cardiac ischemia presents significant surgical challenges.
• A staged surgical approach is typical, but determining the optimal sequence can be clinically complex.
• Unstable cardiac status in patients with acute peripheral arterial occlusion requires careful consideration.

Observation:

• A 49-year-old male presented with acute infrarenal aortic occlusion and concurrent cardiac ischemia.
• The patient's unstable condition necessitated an immediate and definitive treatment strategy.
• Standard protocols often involve separate interventions, potentially increasing patient risk.

Findings:

• A successful single-stage surgical procedure was performed, involving ascending aorta-to-bifemoral bypass and saphenous vein grafting to the left anterior descending artery.
• This approach facilitated concomitant coronary and peripheral vascular revascularization.
• Utilizing the ascending aorta as a high-flow inflow source proved feasible and effective.

Implications:

• A single-stage surgical strategy can be a viable and practical option for managing unstable patients with combined aortic and coronary disease.
• This case highlights the potential benefits of a combined approach, possibly reducing overall treatment time and risk.
• Further investigation into single-stage interventions for complex cardiovascular and peripheral vascular disease is warranted.