| Beneficial Effects of Preoperative
Coronary Angiography and Coronary Artery Revascularization in
Patients Undergoing Surgery for Abdominal Aortic Aneurysm |
(Department of Cardiovascular Surgery, Osaka National
Hospital, Osaka, Japan)
| Yasuyuki Sasaki |
Fumitaka Isobe |
Seiji Kinugasa |
| Yoshiei Shimamura |
Hiroshi Kumano |
Keima Nagamachi |
| Yasuyuki Kato |
Hideki Arimoto |
|
|
It is well known that patients with
abdominal aortic aneurysms (AAA) have a high incidence of coronary
artery disease (CAD), and that the major cause of death in patients
undergoing aneurysmectomy is acute myocardial infarction. A total
of 53 patients (mean age, 71 years) underwent elective repair
of AAA between January 1991 and November 1999. In an attempt
to reduce early and late mortality caused by myocardial infarction,
coronary angiography (CAG) was performed in all cases. Significant
CAD was found in 23 patients (43%), with triple vessel disease
in 1 patient (2%), double vessel disease in 5 patients (9%),
single vessel disease in 16 patients (30%) and left main in 1
patient (2%). Ten patients (19%) in whom CAD was detected by
CAG had no history of CAD and displayed no ischemic findings
on ECG. In 4 patients (8%), AAA repair was performed 2 (mean)
months after coronary artery bypass grafting (CABG). Percutaneous
transluminal coronary angioplasty (PTCA) was performed in 8 patients
(23%) 19 days (mean) prior to AAA surgery. No patient had a perioperative
myocardial infarction either following coronary revascularization
(CABG and PTCA) or AAA resection. Moreover, there was only one
operative death after abdominal aneurysmectomy (2%), in a patient
who was 70 years old with chronic hemodialysis and who died due
to multiple organ failure caused by uncontrollable adhesional
ileus. The results of this study emphasize the importance of
preoperative routine coronary angiography following coronary
artery revascularization to enhance the operative outcome of
AAA repair.
Jpn. J. Cardiovasc. Surg. 30: 63-67 (2001) |
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