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Coronary artery revascularization before peripheral vascular surgery in patients with peripheral arterial disease

Hideki Miyachi1, Jun Tanabe, Eitaro Kodani

  • 1Division of Cardiology, National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan, hidep-@nms.ac.jp.

Cardiovascular Intervention and Therapeutics
|October 15, 2013
PubMed

Insights

Coronary artery revascularization before peripheral vascular surgery did not improve long-term outcomes for patients with coronary artery disease and inducible ischemia. Pre-operative evaluation is key for treatment strategy.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Cardiovascular Research

Background:

  • Peripheral arterial disease (PAD) frequently coexists with coronary artery disease (CAD), increasing perioperative cardiac risks during peripheral vascular surgery (PVS).
  • The benefit of routine coronary artery revascularization before PVS in patients with PAD and CAD is not well-established.

Purpose of the Study:

  • To evaluate the long-term efficacy of coronary artery revascularization in patients with PAD undergoing elective PVS.
  • To compare outcomes between patients with CAD who underwent revascularization, those treated medically, and those without CAD.

Main Methods:

  • Retrospective analysis of 114 patients undergoing elective PVS.
  • Coronary angiography (CAG) performed preoperatively.
  • Groups: No-CAD (n=62), CAD-Medical (n=37), CAD-Revascularization (n=15) based on CAG findings and ischemia assessment.

Main Results:

  • Postoperative 30-day event rates were 8.1% (No-CAD), 10.8% (CAD-M), and 26.7% (CAD-R) (P=0.13).
  • Long-term cardiovascular event rates were 21.0% (No-CAD), 21.6% (CAD-M), and 33.3% (CAD-R) (P=0.60).
  • Outcomes were comparable across groups, suggesting no significant benefit from revascularization in this cohort.

Conclusions:

  • Coronary artery revascularization prior to elective PVS did not yield superior long-term outcomes compared to medical management or no CAD.
  • Comprehensive evaluation of CAD and myocardial ischemia is crucial for determining optimal therapeutic strategies before PVS.
  • Individualized treatment decisions for CAD in PAD patients undergoing PVS are warranted.

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