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[Surgical treatment of coexistent aortic, peripheral vascular and coronary disease]
Y Hirooka1, M Tahara, N Kikuchi
1Department of Thoracic Surgery, Juntendo University, School of Medicine, Tokyo, Japan.
Insights
The priority of surgical treatment for combined aortic aneurysm and coronary artery disease (CAD) involves staged operations, with simultaneous surgery reserved for specific thoracic aneurysms. This approach aims to minimize risks and improve patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Context:
- Coexistent aortic and coronary artery disease (CAD) presents complex management challenges.
- Aortic aneurysms, particularly when combined with severe CAD, require careful surgical planning.
- Perioperative myocardial infarction is a significant risk in patients undergoing aortic surgery.
Purpose:
- To establish surgical priorities for patients with combined aortic aneurysms and severe CAD.
- To evaluate the safety and efficacy of different surgical strategies.
- To determine the incidence of CAD in patients with aortic and peripheral vascular disease.
Summary:
- A review of 19 cases with aortic aneurysms and severe CAD examined surgical priorities.
- Strategies included graft replacement for aneurysms, with aortocoronary bypass surgery (CABG), angioplasty, or medical management for CAD.
- Staged operations were preferred, with simultaneous surgery reserved for ascending and proximal arch aneurysms, showing no operative mortality.
Impact:
- Routine coronary angiography before aortic surgery identified a high incidence (46.1%) of coexistent CAD.
- The findings inform surgical decision-making for complex cardiovascular conditions.
- This strategy helps mitigate risks like perioperative myocardial infarction in high-risk patients.
Abstract:
To determine the priority of the surgical treatment of coexistent aortic and coronary disease (CAD), we reviewed 19 cases of aortic aneurysm combined with severe coronary lesions who underwent operation from Jan, 1984 to Aug, 1989. There were 15 cases of abdominal and 4 cases of thoracic aneurysm. All patients had graft replacement for the aneurysm and 12 patients had elective aortocoronary bypass surgery (CABG), one had percutaneous transluminal coronary angioplasty and 6 received medical treatment for CAD. In 6 cases, CABG preceded abdominal aneurysm operation. In 3 cases of ascending thoracic aneurysm, simultaneous coronary and aortic operation were performed. There were no early and late operative death. In an attempt to reduce perioperative myocardial infarction which is one of the most frequent complications of aneurysmal operation, we performed routine coronary angiogram before operation. In 104 patients considered for elective aortic and peripheral vascular disease, coronary angiogram were performed. The incidence of coexistent coronary artery disease in peripheral vascular and aortic disease were 46.1%. The incidence of multiple vessel CAD in patients with aortic and peripheral disease were high. Our surgical strategy for coexistent aortic, peripheral vascular and coronary disease is basically staged operation and simultaneous operation are performed only in ascending and proximal arch aneurysm.