PREOPERATIVE CORONARY ASSESSMENT BEFORE A BDOMINAL AORTIC-ANEURYSM REPAIR - A PRAGMATIC ATTITUDE

High prevalence of coronary artery disease in patients with AAA leads to a high rate of peri-operative cardiac complications. Coronary insuf ficiency is thus the cause of 40 to 60 % of post-operative deaths afte r aortic surgery. Demonstration of coronary insufficiency depends on t he clinical history, electrocardiographic evidence, non-invasive exami nations and coronarography. Diagnosis is based on non-invasive tests, and of primary importance exercise tests, which have a high sensitivit y. Specificity for predicting post-operative cardiac complications rem ains low but can be improved by combining with other tests (for exampl e exercise test and Holter recording) or with other clinical parameter s. Coronarography provides a precise map of the coronary status but gi ves little information on functional impairment of encountered lesions . Finally, besides the cost and a certain degree of morbidity, coronar ography increases the number of indications for revascularizations wit h the inconvenience of its intrinsic mortality and also retards the op eration increasing the risk of rupture. The evaluation of cardiac risk before surgery must be based on correct use of non-invasive tests, li miting coronarography to cases with frankly positive tests (J Mal Vasc 1996; 21, Suppl. A : pages 1-9).