Usefulness of PTCA for the Treatment of Abdominal Aortic Aneurysm Associated with Coronary Artery Disease

Abstract

Coronary artery disease (CAD) is common in patients with abdominal aortic aneurysms (AAA). Myocardial infarction is the leading cause of postoperative death and late death after AAA repair. In an attempt to reduce the incidence of perioperative myocardial infarction, routine coronary angiography has been recommended in all patients scheduled for elective AAA repair, and staged myocardial revasculization has been performed using percutaneous transluminal coronary angioplasty (PTCA), if indicated. From March 1987 to February 1995, 40 consecutive patients receiving elective repair of AAA underwent preoperatively coronary angiography. Twenty-one of the 40 patients (53%) had CAD, and in 9 coronary revasculization was indicated. Seven of those patients underwent successful PTCA prior to surgery. One patient had PTCA following surgery for AAA because of technical difficulties in advancing a catheter due to the elongated abdominal aorta. The other patient with triple vessel disease was considered to be unsuitable for PTCA in those days and underwent coronary bypass grafting before AAA repair. There was no operative mortality or perioperative myocardial infarction during and after the repair of AAA. Our results suggest that PTCA should be considered one of the best treatment strategy options for patients with coexistent AAA and CAD.