Abstract
Background: Patients with abdominal aortic aneurysm (AAA) often have complication of coronary artery disease (CAD) and surgical strategy has a great impact on outcome. Our objective was to evaluate our surgical strategy for patients with AAA and CAD based on the surgical outcomes. Methods: From January 1, 2002 to April 30, 2006, 323 patients underwent solitary CABG and surgery for AAA was performed in 317 patients. Thirty-nine patients with CAD and AAA were surgically treated, 33 men and 6 women with a mean age of 74 ± 7.2 years old (54-87 years). Emergency cases were excluded. Patients with an AAA diameter of 55 mm or more or proximal LAD lesions underwent concomitant operation and the others had additional PCI or prior CABG. Concomitant CABG and AAA operation was performed in 22 patients (combined group), AAA operation following CABG in 8 (prior CABG group), and AAA operation with additional PCI in 9 (additional PCI group). Concomitant operation included OPCAB in 14 patients and MIDCAB in 8 as CABG procedures. Eight patients with prior CABG had AAA operation at a mean of 6.3 ± 4.5 weeks after CABG (3-16 weeks). PCI was carried out before AAA operation in 6 patients and after operation in the remaining cases. The preoperative, intraoperative, and postoperative factors were compared among the 3 groups. Follow-up was carried out for 1.7 ± 1.2 years (2 weeks-3.9 years). Results: Hospital mortality was 2.6%: one patient with concomitant operation who had preoperative renal dysfunction, anemia, and low platelet count, died of acute renal and hepatic failure. Morbidity in all other patient was not significantly different. No AAA rupture was noted in the patients with treatment for CAD before AAA operation. Conclusion: Surgical treatment for patients with CAD and AAA was performed with acceptable outcomes. Meticulous surgical strategy is required in high-risk patients.
