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Coronary artery revascularization concomitant with vascular surgery
T Isomura1, K Hisatomi, N Hayashida
1Second Department of Surgery, Kurume University Hospital, Fukuoka, Japan.
Insights
This study found that combining coronary artery bypass grafting (CABG) with vascular surgery in one operation is safe and effective. Patients experienced no deaths and similar intensive care unit stays compared to single procedures.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Surgical Innovation
Background:
- Coronary artery bypass grafting (CABG) and vascular surgery are common treatments for cardiovascular and vascular diseases, respectively.
- Typically, patients undergo CABG first, followed by vascular surgery at a later time.
- The feasibility of performing both procedures simultaneously has not been extensively studied.
Purpose of the Study:
- To assess the safety and clinical outcomes of performing combined coronary artery bypass grafting (CABG) and vascular surgery in a single operative session.
- To evaluate the feasibility of this combined approach in patients requiring both cardiac and peripheral vascular interventions.
Main Methods:
- A retrospective analysis of 16 patients who underwent combined CABG and vascular surgery between 1988 and 1995.
- Assessment of operative outcomes, including mortality, operative time, and intensive care unit (ICU) stay.
- Clinical results and postoperative management were evaluated.
Main Results:
- No operative or hospital deaths were recorded in the study cohort.
- The average operative time was 421 minutes, with a mean ICU stay of 3.6 days.
- One case highlighted the importance of preoperative angiography of the left internal thoracic artery (ITA) when it serves as a collateral for ischemic limbs.
Conclusions:
- Combined CABG and vascular surgery is a safe procedure with good clinical outcomes for patients needing both interventions.
- While the combined operation is longer, the postoperative ICU stay is comparable to single procedures.
- Careful preoperative assessment, including potential ITA collateralization, is crucial for successful combined surgeries.
Abstract:
Patients with vascular disease and coronary disease are usually treated initially by coronary artery bypass grafting (CABG), and vascular surgery is generally performed later. In this study we assessed the feasibility of combined CABG and vascular surgery in a single operation. Between 1988 and 1995, 16 patients received combined operations for vascular and cardiac lesions and the clinical results were assessed. There were no operative or hospital deaths. The mean time for operation was 421 min and the duration of the stay in the intensive care unit (ICU) was a mean of 3.6 days. In one patient with an ischemic left leg, the left internal thoracic artery (ITA) had become a collateral source of the ischemic leg, and the need for preoperative angiography of the ITA in such patients was indicated. The combined operation clearly takes longer than either vascular surgery or CABG alone, but the length of the postoperative intensive care unit stay was essentially the same as that after a single operation and the patient was still managed safely after the combined operation. In patient requiring both operations, the combined procedure therefore appears to be safe and to have a good clinical outcome.