Influence of Coronary Artery Disease on Operative Mortality and Long-Term Survival After Abdominal Aortic Aneurysm Repair

Sasaki, Yasuyuki; Isobe, F; Kinugasa, Seiji; Iwata, Keiji; Murakami, Tadahiro; Saito, Motoko; Motoki, Manabu

doi:10.1007/s00595-003-2708-y

Cited by 17 publications

(13 citation statements)

References 7 publications

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“…As regards aortic aneurismal disease associated with CAD, the prevalence of this association has been reported to range from 4.4 to 7% [43][44][45]. A knowledge of aortic involvement in such atherosclerotic phenomena may influence the operative strategy in patients undergoing urgent coronary angiography privileging complete revascularization which reduces the risk of cardiac events in patients undergoing thoracic aortic surgery or in the case of severe thoraco-abdominal aneurysm by referring the patient for combined surgical management which has low mortality and good event-free survival rates [46][47][48]. Although sometimes it may be useful and of good sense to image the aortoiliac vessels before aortic balloon pump or percutaneous coronary interventions, we failed in obtain sufficient data about appropriateness of coincident aortoiliac angiography due to the trivial number of study and their retrospective nature: routine aortoiliac angiography should be considered malpractice unless it is performed as part of abdominal aortography in order to detect RA stenosis in catheterization laboratories with peripheral imaging equipment utilizing a larger (15¢¢) intensifier.…”

Section: Discussionmentioning

confidence: 99%

Malpractice in Invasive Cardiology: Is Angiography of Abdominal Aorta or Subclavian Artery Appropriate in Patients Undergoing Coronary Angiography?

Rigatelli¹,

Rigatelli²

2005

Int J Cardiovasc Imaging

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Consistent evidence of appropriateness of renal angiography in selected patients undergoing coronary angiography have been produced in literature. IMA and AOI angiography seem to be not justified unless they are part of SA in patients scheduled for arterial conduit with brachial differential pressure, thoracic irradiation or surgery, or of abdominal angiography to detect RA stenosis in laboratories with radiological digital peripheral equipment.

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Section: Discussionmentioning

confidence: 99%

Malpractice in Invasive Cardiology: Is Angiography of Abdominal Aorta or Subclavian Artery Appropriate in Patients Undergoing Coronary Angiography?

Rigatelli¹,

Rigatelli²

2005

Int J Cardiovasc Imaging

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show abstract

“…A knowledge of aortic involvement in such atherosclerotic phenomena may influence the operative strategy in patients undergoing urgent coronary angiography resulting in complete revascularization, thus reducing the risk of cardiac events in patients undergoing thoracic aortic surgery; or, in the case of severe thoraco-abdominal aneurysm, by referring the patient for combined surgical management, which has low mortality and good event-free survival rates. [23][24][25][26][27][28] Abdominal aortography should be considered not only for assessing the renal artery but also for evaluating aortoiliac occlusive diseases. 29,30 Differences in entry criteria, imaging techniques and protocols, and lesion severity evaluation methods may contribute to this variety of results.…”

Section: Discussionmentioning

confidence: 99%

Concomitant peripheral vascular and coronary artery disease: A new dimension for the global endovascular specialist?

Rigatelli¹,

Roncon²,

Bedendo³

et al. 2005

Clin Cardiol

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SummaryBackground: Early and accurate diagnosis of peripheral atherosclerosis is of paramount importance for global management of patients with known coronary artery disease (CAD).Hypothesis: We sought to evaluate retrospectively the prevalence and clinical relevance of significant abdominal vessel stenosis or aneurysm (AVA) in patients undergoing coronary angiography.Methods: Medical records of consecutive patients who underwent coronary angiography at two public institutions over a 12-month period were evaluated. Angiographic results of patients who underwent diagnostic abdominal aorta angiography, based on clinical criteria, to evaluate abdominal vessels at the same time as coronary angiography were analyzed.Results: During the study period, AVA was reported in 180 (35.7%) of 504 consecutive patients (335 men, mean age 68 ± 13.8 years): renal artery stenosis was found in 13.1% of cases (66 patients), aortoiliac artery disease in 13.7% (69 patients), and aortic aneurysmal disease in 8.9% (45 patients). Logistic regression analyses revealed ≥ 3-vessel CAD (odds ratio [OR] 9.917 , p = 0.002), age > 65 years (OR 3.817, p = 0.036), ≥ 3 risk factors (OR 2.8, p = 0.048) as independent predictors of AVA.Conclusion: Multiple vascular atherosclerotic distributions are frequent in elderly patients who have multivessel CAD and

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“…1,4 -8 The majority of thoracic surgeons have recommended routine coronary arteriography (CAG) preoperatively in all patients with AAA requiring surgical repair. 1,9,10 Recently, however, a randomized trial carried out in patients undergoing major vascular surgery failed to demonstrate the benefits of prophylactic treatment with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery for the clinical outcomes in patients with angiographically determined coronary stenosis. 11 A controversy has arisen regarding the necessity of routine CAG and prophylactic invasive treatment for CAD prior to surgery for AAA.…”

Section: Introductionmentioning

confidence: 99%

Management of Coronary Artery Disease in Patients Undergoing Elective Abdominal Aortic Aneurysm Open Repair

Hosokawa¹,

Takano²,

Aoki³

et al. 2008

Clinical Cardiology

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Background The efficacy of prophylactic coronary revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in patients with abdominal aortic aneurysm (AAA) scheduled for open repair surgery remains controversial. Hypothesis Concomitant coronary artery disease (CAD) with no inducible ischemia can be medically treated in AAA patients undergoing open repair as long as the existence of CAD is recognized. Method A retrospective analysis of acute and long‐term outcomes was performed for 122 patients with AAA who underwent coronary arteriography (CAG) for preoperative evaluation followed by elective open repair. Results Preoperative CAG revealed no CAD in 54 patients (non‐CAD group) and the existence of CAD in 68 patients. Prophylactic PCI or CABG surgery was performed in 16 patients (CAD‐PCI/CABG group) with symptomatic angina, ischemia proven by pharmacological stress scintigraphy, or coexistence of reduced cardiac contraction and coronary stenosis in multiple vessels. Medical treatment was administered to 52 patients who had no signs of ischemia (CAD‐medical group). During the perioperative period, no cardiac event occurred irrespective of the existence of CAD. The long‐term outcomes in the CAD‐medical group were equivalent to those in the non‐CAD group. In the CAD‐PCI/CABG group, the cardiac event‐free rate was comparable with that of other groups, although mortality was higher. Conclusion In patients undergoing AAA open repair, medical treatment for concomitant CAD with no obvious inducible ischemia does not confer unfavorable outcomes. Although prophylactic coronary revascularization possibly prevents future cardiac events, it appears to be necessary in a very limited number of cases. Copyright © 2008 Wiley Periodicals, Inc.

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Influence of Coronary Artery Disease on Operative Mortality and Long-Term Survival After Abdominal Aortic Aneurysm Repair

Abstract: These results emphasize the importance of routine coronary angiography and subsequent coronary revascularization to improve early and late survival rates after AAA repair.

Cited by 17 publications

References 7 publications

Malpractice in Invasive Cardiology: Is Angiography of Abdominal Aorta or Subclavian Artery Appropriate in Patients Undergoing Coronary Angiography?

Malpractice in Invasive Cardiology: Is Angiography of Abdominal Aorta or Subclavian Artery Appropriate in Patients Undergoing Coronary Angiography?

Concomitant peripheral vascular and coronary artery disease: A new dimension for the global endovascular specialist?

Management of Coronary Artery Disease in Patients Undergoing Elective Abdominal Aortic Aneurysm Open Repair

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