[Coronary assessment and surgery for aortic aneurysm: systematic coronarography]

Area of Science:

• Cardiology
• Vascular Surgery
• Epidemiology

Background:

• Peripheral vascular disease (PVD) is strongly associated with increased risk of coronary heart disease (CHD).
• Vascular surgeons must proactively identify latent coronary lesions in PVD patients to mitigate risks of perioperative and postoperative decompensation.
• Current guidelines for coronary angiography in PVD patients are debated, particularly for asymptomatic individuals.

Purpose of the Study:

• To review current evidence and propose a practical approach for evaluating coronary artery disease (CAD) risk in patients with PVD.
• To guide vascular surgeons in managing asymptomatic coronary lesions in the context of PVD surgery.

Main Methods:

• Analysis of large international series on lesion prevalence and outcomes in PVD patients.
• Review of diagnostic modalities for assessing coronary risk in PVD, including invasive (coronarography) and non-invasive methods.
• Evaluation of the reliability and applicability of non-invasive cardiac testing in the PVD population.

Main Results:

• Coronarography is indicated for symptomatic PVD patients or those with a history of CHD.
• Non-invasive cardiac testing has limitations in reliability and feasibility for PVD patients.
• A practical management strategy involves analyzing lesion data from international studies and considering cardiac exploration for intermediate risk cases.

Conclusions:

• A structured approach is necessary for managing coronary risk in PVD patients undergoing surgery.
• Cardiac exploration for ischemia should be considered post-initial workup to refine management strategies for intermediate-risk PVD patients.
• Integrating epidemiological data and clinical assessment aids in optimizing surgical outcomes for PVD patients with potential CAD.