A premise of cardiac risk stratification is that the added risk of cor
onary artery bypass grafting (CABG) is offset by the improved safety o
f subsequent vascular reconstruction (VR). We questioned if elective C
ABG is patients with severe peripheral vascular disease (PVD) is a rel
atively high-risk procedure. A cohort study of 680 elective CABG patie
nts from January 1993 to December 1994 was performed using three mutua
lly exclusive outcomes of complication-free survival, morbidity, and m
ortality. Patient characteristic, operative, and outcome data were pro
spectively collected. Retrospective review determined that 58 patients
had either a standard indication for or a history of VR. Overall CABG
mortality was 2.5%, with statistically similar but relatively higher
rates for PVD as compared to non-PVD patients. In contrast, major morb
idity occurred at rates 3.6-fold higher in PVD patients (39.7%) than i
n disease-free patients (16.7%) after adjustment for the effects of pa
tient and operative variables (odds ratio [OR] 3.67, 95% confidence in
terval [CI] 1.93-6.99). CABG morbidity in the PVD patient was most lik
ely in those patients with aortoiliac (OR 9.51, CI 3.20-28.27) and aor
tic aneurysmal (OR 5.24, CI 1.28-21.41) disease types. CABG in PVD pat
ients is associated with significant major morbidity. Such morbidity m
ay preclude or alter the timing of subsequent VR.