ROUTINE CORONARY ARTERIOGRAPHY BEFORE ABDOMINAL AORTIC-ANEURYSM REPAIR

BACKGROUND: AS cardiac complications constitute the principal cause of early and late morbidity and mortality after the surgical treatment o f abdominal aortic aneurysm (AAA), a prospective study was planned to evaluate the effects of revascularization of coronary arteries on surv ival after AAA repair during early and long-term follow-up periods. PA TIENTS AND METHODS: A total Of 125 patients underwent elective repair of AAA between 1986 and 1994. Coronary arteriography was performed in all cases. Ail cases with critical left anterior descending artery (LA D) lesions underwent a coronary artery bypass operation either simulta neously or shortly before AAA repair. In addition, percutaneous transl uminal coronary angioplasty (PTCA) was performed for symptomatic and c ritical stenosis of arteries other than the LADS, or if noncritical bu t symptomatic stenosis of the LADs existed. Early and late follow-up d ata were obtained for all cases, and late-term cumulative survival rat es were calculated. RESULTS: Coronary artery lesions were found in 66 (53%) cases. In 24 cases, AAA repairs were performed 2.3 (mean) months after coronary artery bypass grafting (CABG), whereas in 4 cases both procedures were performed simultaneously. PTCA was performed in 4 cas es 3 to 4 days prior to the abdominal surgery. Even though the coronar y artery lesions were found inoperable in 7 cases, these patients unde rwent repair of AAA because of rapidly expanding and painful aneurysms . Early mortality rate was 4% (5 cases), in which 3 of these were from the group inoperable for CABG, A mean follow-up of 3.17 years (3 to 8 7 months) was achieved for all discharged patients. Cumulative surviva l rates for 6 months and 1, 2, 3, and 6 years were 99%, 99%, 95%, 93%, and 89%, respectively. CONCLUSIONS: The results of this study emphasi ze the importance of coronary artery revascularization for early, and especially for late, survival after AAA repair.