Optimal Timing of Abdominal Aortic Aneurysm Repair After Coronary Artery Revascularization

Abstract

ObjectiveThe authors ascertained the optimal timing of repair of an abdominal aortic aneurysm (AAA) after coronary artery revascularization. Summary Background DataCardiac events are the most common cause of death after elective repair of AAA. Preoperative coronary revascularization has significantly reduced postoperative cardiac complications after elective AAA repair. Currently, most patients undergo repair of asymptomatic AAA within 6 months after the coronary revascularization. MethodsThe authors performed a retrospective review of patients who underwent repair or scheduled repair of an asymptomatic AAA within 6 months after coronary artery bypass graft (CABG) between March 1988 and October 1993. ResultsThere was no mortality in the group of patients (n = 14) who underwent repair of AAA simultaneously or within 14 days of coronary revascularization. In contrast, there was a significantly increased mortality rate of 3 of 9 (33%) in patients scheduled to undergo repair of the AAA more than 2 weeks after coronary revascularization (p < 0.05). All nonsurvivors died between 16 and 29 days after CABG, and died as a result of ruptured AAA. ConclusionElective AAA repair should be undertaken simultaneously or within 2 weeks of coronary artery revascularization because of an increased risk of postoperative AAA rupture seen after this time period. In addition, simultaneous or early postoperative AAA repair does not increase the overall operative risk. 693

Timing of high‐risk vascular surgery following coronary artery bypass surgery: A 10‐year experience from an academic medical centre*

“…Blackbourne et al [12] reported that 3 ⁄ 9 patients who were to have AAA repair > 2 weeks after CABG died of AAA rupture between 16 and 29 days following CABG, while 14 patients who had a staged repair of AAA within 14 days of CABG all survived. Likewise, Acinapura et al [13] (n = 42) and Paty et al [14] (n = 30) also reported that abdominal aortic surgery may be performed within a short time (mean duration of about 2 weeks) following CABG, with low operative mortality rates (0% in the two reports) for the vascular surgery.…”

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

“…On the other hand, the median interval between CABG and AAA repair in this series was 60 days when staged aneurysm repair was done. Blackbourne and colleagues 9 insisted that elective AAA repair should be done simultaneously or within 2 weeks of CABG due to the increased risk of postoperative rupture of the aneurysm after this period. Patients with very large aneurysms should undergo AAA repair within 1-2 weeks after coronary revascularization, and repair of the aneurysm combined with CABG should be considered if the patient is able to tolerate simultaneous procedures.…”

“…[1][2][3][4][5][6][7][8][9] For this reason, cardiac assessment is an important part of the preoperative evaluation before elective AAA repair; however, there is still much controversy about the best methods to evaluate CAD associated with AAA. While some authors suggest routine preoperative coronary angiography, 1-3 others insist on noninvasive and selective evaluation of the heart using two-dimensional echocardiography, thallium scanning, or selective coronary angiography, based on the severity of cardiac symptoms and the noninvasive evidence of CAD.…”

Anesthesia for Open Abdominal Aortic Aneurysm Repair

“…40,41 The CABG can be done on or off cardiopulmonary bypass (CPB). [42][43][44][45][46][47] In pump cases, both CABG and AAA repair were done while on CPB in some patients while in others, AAA resection was performed after weaning from CPB. 47 CABG on CPB is known to activate inflammatory mediators, produce coagulopathy and embolic phenomenon leading to end organ damage.…”