Original Article

Abdominal Aortic Aneurysm and Significant Coronary Artery Disease: Strategies and Options

Authors: Jean Marie Ruddy, MD, William Yarbrough, MD, Thomas Brothers, MD, Jacob Robison, MD, Bruce Elliott, MD

Abstract


Objectives: The optimal treatment for patients requiring intervention for coronary artery disease (CAD) and concomitant large or symptomatic abdominal aortic aneurysm (AAA) remains problematic.


Methods: Retrospective analysis was performed of 32 patients with symptomatic or large (>6 cm) AAA along with significant CAD treated over the past fifteen years at a university hospital.


Results: Mean AAA diameter was 6.6 cm. CAD involved 3 or more vessels in all patients. Fifteen patients underwent staged coronary artery bypass grafting (CABG) followed by open AAA repair, with two (13%) dying as a result of aneurysm rupture in the early postoperative period. No major complications were encountered among five patients receiving staged coronary angioplasty before open AAA repair and two patients undergoing staged CABG followed by endovascular aneurysm repair. Ten patients underwent concomitant CABG and AAA repair, with a single intraoperative death (10%). No differences in morbidity were observed among patients undergoing concomitant procedures as compared with those subjected to staged procedures.


Conclusions: Minimally invasive interventions for coronary revascularization and aortic aneurysm repair appear to be safe and effective options in properly selected high-risk patients. While optimal management must be individualized, these data suggest that either staged or concomitant CABG and AAA repair may be viable options when minimally invasive interventions are not feasible.



This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Crawford ES, Saleh SA, Babb JW III, et al. Infrarenal abdominal aortic aneurysm: factors influencing survival after operation performed over a 25-year period. Ann Surg 1981;193:699–709.
 
2.Hertzer NR, Beven EG, Young JR, et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg 1984;199:223–233.
 
3.Bergersen L, Kiernan MS, McFarlane G, et al. Prevalence of abdominal aortic aneurysms in patients undergoing coronary artery bypass. Ann Vasc Surg 1998;12:101–105.
 
4.Landesberg G, Mosseri M, Wolf YG, et al. Preoperative thallium scanning, selective coronary revascularization, and long-term survival after major vascular surgery. Circulation 2003;108:177–183.
 
5.Onwudike M, Barnard M, Singh-Ranger R, et al. For debate: concomitant critical coronary arterial disease and abdominal aortic aneurysm-timing of corrective procedures. Cardiovasc Surg 2000;8:333–339.
 
6.Blackbourne LH, Tribble CG, Langenburg SE, et al. Optimal timing of abdominal aortic aneurysm repair after coronary artery revascularization. Ann Surg 1994;219:693–696; discussion 696–698.
 
7.Gade PV, Ascher E, Cunningham JN, et al. Combined coronary artery bypass grafting and abdominal aortic aneurysm repair. Am J Surg 1998;176:144–146.
8.El-Sabrout RA, Reul GJ, Cooley DA. Outcome after simultaneous abdominal aortic aneurysm repair and aortocoronary bypass. Ann Vasc Surg 2002;16:321–330.
 
9.Wolff T, Baykut D, Zerkowski HR, et al. Combined abdominal aortic aneurysm repair and coronary artery bypass: presentation of 13 cases and review of the literature. Ann Vasc Surg 2006;20:23–29.
 
10.Westaby S, Parry A, Grebenik CR, et al. Combined cardiac and abdominal aortic aneurysm operations. The dual operation on cardiopulmonary bypass. J Thorac Cardiovasc Surg 1992;104:990–995.
 
11.Mohr FW, Falk V, Autschbach R, et al. One-stage surgery of coronary arteries and abdominal aorta in patients with impaired left ventricular function. Circulation 1995;91:379–385.
 
12.King RC, Parrino PE, Hurst JL, et al. Simultaneous coronary artery bypass grafting and abdominal aneurysm repair decreases stay and costs. Ann Thorac Surg 1998;66:1273–1276.
 
13.Paty PS, Darling RC III, Chang BB, et al. Repair of large abdominal aortic aneurysm should be performed early after coronary artery bypass surgery. J Vasc Surg 2000;31:253–259.
 
14.McFalls EO, Ward HB, Moritz TE, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med 2004;351:2795–2804.
 
15.Hassan SA, Hlatky MA, Boothroyd DB, et al. Outcomes of noncardiac surgery after coronary bypass surgery or coronary angioplasty in the Bypass Angioplasty Revascularization Investigation (BARI). Am J Med 2001;110:260–266.
 
16.Mendoza CE, Virani SS, Shah N, et al. Noncardiac surgery following percutaneous coronary intervention. Catheter Cardiovasc Interv 2004;63:267–273.
 
17.Leibowitz D, Cohen M, Planer D, et al. Comparison of cardiovascular risk of noncardiac surgery following coronary angioplasty with versus without stenting. Am J Cardiol 2006;97:1188–1191.
 
18.Jordan WD, Alcocer F, Wirthlin DJ, et al. Abdominal aortic aneurysms in “high-risk” surgical patients: comparison of open and endovascular repair. Ann Surg 2003;237:623–629; discussion 629–630.