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Combined coronary artery bypass and abdominal aortic aneurysmectomy: appropriate management in selected cases
S M Taylor1, R M Fujitani, J C Myers
1Department of General Surgery, Wilford Hall USAF Medical Center, Lackland Air Force Base, Tex.
Insights
Patients with aortic aneurysms often have coronary artery disease. A combined surgery for coronary artery bypass and aneurysmectomy is a viable option for carefully selected patients with unstable coronary disease and large aortic aneurysms.
Area of Science:
- Cardiovascular Surgery
- Aortic Aneurysm Disease
- Coronary Artery Disease
Background:
- Concomitant coronary artery disease (CAD) in patients with aortic aneurysms increases perioperative risks.
- Severe, surgically correctable CAD is typically treated before aortic aneurysm repair to reduce cardiac morbidity and improve survival.
Observation:
- Rarely, patients present with both unstable coronary artery disease and a large, symptomatic aortic aneurysm.
- This clinical scenario necessitates consideration of alternative management strategies.
Findings:
- A single-stage combined procedure, including coronary artery bypass grafting (CABG) followed by aortic aneurysmectomy, is presented as a feasible option.
- This approach was successfully illustrated in a specific case report.
Implications:
- Combined CABG and aneurysmectomy offers a reasonable alternative for carefully selected patients with critical comorbidities.
- This strategy may improve outcomes for patients facing simultaneous life-threatening cardiovascular conditions.
- Further evaluation in select patient populations is warranted to define the full scope of this combined surgical approach.
Abstract:
Patients with aortic aneurysms frequently have concomitant coronary artery disease, which carries the potential for significantly increased perioperative morbidity. Most cases of severe surgically correctable coronary artery disease can and should be treated by a separate operation before aneurysmectomy to lower operative cardiac morbidity and enhance long-term survival. Infrequently, a patient can have both unstable coronary disease and a large symptomatic aortic aneurysm. In this situation, a single procedure combining coronary artery bypass followed by aneurysmectomy, as illustrated by this case report, is a reasonable option and should be considered in the cases of carefully selected patients.