Associated vascular lesions in patients undergoing coronary artery bypass grafting

Abstract

Atherosclerotic involvement of extracoronary arteries in patients undergoing myocardial revascularization can cause severe postoperative complications and increase postoperative mortality. Between January and November 1998, routine preoperative echo-Doppler study of carotid vessels, abdominal aorta and iliac-femoral arteries was performed in all patients undergoing coronary artery bypass grafting (CABG) at our institution, in order to assess the prevalence and the degree of associated vascular lesions. Correlations between echo-Doppler findings, angiographic patterns of coronary lesions and atherosclerotic risk factors were analyzed in all cases. Among 302 patients undergoing CABG, 186 (61.6%) had carotid disease, with a haemodynamically significant stenosis (>70%) of internal carotid in 31 (10.2%). Twenty-three patients had asymptomatic severe carotid disease. A significant correlation between severity of coronary disease and prevalence of severe carotid disease was found (p = 0.02). An abdominal aortic dilatation (diameter > 25 mm) was found in 20 cases (6.6%), with a diameter >35 mm in 7 patients (2.3%), 6 with triple-vessel coronary disease, and 1 with double-vessel disease. Atherosclerotic lesions of iliac-femoro-popliteal axis were found in 165 (54.6%) patients, with a strong correlation to the severity of coronary disease (p = 0.02); lesions were haemodynamically significant (> 70%) in 48 (15.8%) cases. Symptoms of carotid and peripheral vascular disease are no reliable predictors of perioperative risk in patients undergoing CABG. Non-invasive complete arterial investigation should be routinely performed in these patients, in order to plan the most suitable operative approach and to prevent perioperative vascular complications.

Diastolic Carotid Artery Wall Shear Stress Is Associated With Cerebral Infarcts and Periventricular White Matter Lesions

“…3,[5][6][7]19 Moreover, any causal correlation between carotid hemodynamics and cerebrovascular pathology could be confounded by similar worsening hemodynamics in the cardiac, vertebrobasilar, or cerebral arteries. 20 In this study PWML, but not DWML, were associated with WSS. Interestingly, previous investigators have found a similar distinction as PWML, but not DWML, were associated with total cerebral blood flow, intima-media thickness, plaques in the carotid artery, and atrial fibrillation.…”

Comparison of the incidences of carotid artery lesion and vertebrobasilary insufficiency with incidence of postoperative stroke in patients who undergo coronary artery bypass graft surgery

“…Yapılan araştırmalar Amerika'da her yıl 300.000'den fazla hastaya KABG uygulandığını gös-termektedir. [20] Koroner arter bypass greftleme ameliyatının ameliyat sonrası birçok komplikasyonu bulunmaktadır ve bunlar içerisinde inme, ameliyat sonrası nörolojik komplikasyonların başında gelen ve en korkulanıdır. İnmeyi önlemeye yönelik birçok çalışma yapılmış olmasına rağmen, KABG sonrası inme halen en önemli mortalite ve morbidite nedenlerinin başında gelmekte ve hastanede kalış süresini, hastane maliyetini artırmakta, hastanın yaşam kalitesini ise azaltmaktadır.…”

The risk of stroke following CABG: one possible strategy to reduce it?

“…There is a general agreement that coronary artery disease represents only a part of a more widespread atherosclerotic disease, and a clear correlation has been found between extent of coronary artery disease and incidence of carotid and peripheral vascular disease [6,15]. The degree of arterial involvement varies according to age, sex, geographic location and risk factors of the population [16].…”

“…D'Agostino et al [18] found in their patients undergoing CABG an incidence of carotid stenosis greater than 50% in 20% of patients, and greater than 80% in 8%. Our previous report showed that 61.6% of patients undergoing CABG have some carotid stenosis, meanwhile 10.2% have a hemodinamically significant carotid stenosis, exposing the patient to the risk of perioperative neurological injury [6].…”

“…carotid bruit or peripheral pulse losses) [5]; others are performing routinely preoperative Echo-Doppler screening of carotid vessels [6].…”