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Routine coronary angiography prior to elective aortic reconstruction: results of selective myocardial
Insights
Routine screening with coronary angiography for severe coronary artery disease (CAD) in patients undergoing peripheral vascular reconstruction identified significant CAD prevalence. Myocardial revascularization before surgery improved outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Elective peripheral vascular reconstruction necessitates evaluation for severe coronary artery disease (CAD).
- Cleveland Clinic implemented routine coronary angiography for patients undergoing elective peripheral vascular reconstruction since 1978.
Purpose of the Study:
- To determine the prevalence of severe, correctable CAD in patients undergoing elective peripheral vascular reconstruction.
- To assess the impact of myocardial revascularization prior to vascular surgery.
Main Methods:
- Retrospective review of patients undergoing elective aortic reconstruction (abdominal aortic aneurysms and aortoiliac disease).
- Coronary angiography performed to identify severe CAD.
- Patients with severe CAD underwent myocardial revascularization before vascular surgery.
Main Results:
- Severe, correctable CAD was found in 23/68 patients with abdominal aortic aneurysms (AAA) and 14/71 with aortoiliac (AI) disease who had clinical suspicion.
- Severe CAD was also detected in 6/27 AAA patients and 6/45 AI patients without clinical suspicion.
- Ninety-six patients underwent elective aortic reconstruction with only one operative death, including 26 with staged cardiac procedures.
Conclusions:
- Routine coronary angiography is valuable for identifying severe CAD in patients undergoing elective peripheral vascular reconstruction.
- Preoperative myocardial revascularization for severe CAD in this population is associated with low operative mortality.
Abstract:
Routine coronary angiography to determine the prevalence of severe coronary artery disease (CAD) has been recommended to all patients under consideration for elective peripheral vascular reconstruction at the Cleveland (Ohio) Clinic since April 1978. Those found to have severe, correctable CAD have been advised to undergo myocardial revascularization prior to performance of elective peripheral vascular operations. Forty-one of the 68 patients with abdominal aortic aneurysms (AAA) and 26 of the 71 patients with aortoiliac occlusive arterial disease (AI) had clinical evidence of CAD; coronary angiography demonstrated severe, correctable CAD in 23 patients with AAA and in 14 patients with AI. Twenty-seven patients with AAA and 45 patients with AI had no clinical evidence of CAD; severe, correctable CAD was found in six patients with AAA and in six patients with AI. Ninety-six patients, including 26 who had staged cardiac procedures performed, have had elective aortic reconstruction, with one operative death.