Abstract
Concomitant coronary artery disease (CAD) and peripheral vascular disease (PVD) are frequently seen. We evaluated the incidence of CAD in patients admitted for the treatment of PVD and the results. Between April 1996 and December 2004, 297 cases underwent abdominal aortic aneurysm (AAA) repair and 164 cases underwent peripheral vascular surgery for arteriosclerosis obliterans (ASO). Since 2001, consecutive 220 cases (AAA: 124, ASO: 96) underwent routine preoperative coronary angiography. Of these, 27 cases (12.3%, AAA: 16, ASO: 11) had episodes of CAD and 71 cases (36.8%, AAA: 40, ASO: 31) had significant coronary stenosis. Of 71 cases, only six cases (8.5%, AAA: 4, ASO: 2) were symptomatic. Coronary angiography revealed 35 cases of one-vessel disease (18.1%, AAA: 20, ASO: 15), 24 of two-vessel disease (12.4%, AAA: 12, ASO: 12), 8 of three-vessel disease (4.1%, AAA: 6, ASO: 2), and 4 left main trunk plus three-vessel disease (2.1%, AAA: 2, ASO: 2). Of 56 cases (12.1%, AAA: 32, ASO: 24) requiring coronary artery bypass grafting (CABG, on pump: 14, off pump: 42), 39 cases (Group C) underwent CABG prior to peripheral vascular surgery, 10 cases (Group P ) underwent peripheral vascular surgery prior to CABG and 7 cases (Group S) underwent CABG and peripheral vascular surgery simultaneously. In Group C, there were 1 operative death due to the rupture of AAA at 4 days after urgent off pump CABG, 2 hospital deaths due to infection and 1 late death. In Group P, there was no death nor cardiac event. In Group S, there was no death but there were 2 cases of mediastinitis and 1 of retroperitoneal hematoma. Because of the high incidence of asymptomatic CAD in patients of PVD, coronary angiography is necessary to evaluate the severity of coronary artery and manage CAD properly before the treatment of PVD. Staged CABG followed by PVD treatment is preferable unless the diameter of AAA exceeds 60 mm or leg ischemia is severe.
