For debate: concomitant critical coronary arterial disease and abdominal aortic aneurysm - timing of corrective procedures

Background. The high prevalence of coronary artery disease (CAD) in patient s with abdominal aortic aneurysm (AAA) is responsible for most < 30-day mor tality and morbidity in elective repair of AAA, The continuing debate regar ding staged or combined surgery for AAA and CAD (coronary artery bypass gra fting - CABG) in the small number of patients with critical degrees of both co-morbidities has not had a significant impact on the greater mortality a nd morbidity when the AAA repair is undertaken using the standard open oper ation. Patients. We report four cases with these combined pathologies which we hav e managed over the last 30 months during which time we have developed techn iques of endolumenal repair of AAA. Conclusions. Whilst it is not possible to make firm recommendations regardi ng management strategy owing mainly to a lack of large series reporting thi s unusual combination of co-morbidities, the options are debated on the bas is of published anecdotal evidence as well as our own case reports. We sugg est that if the AAA is non-tender and/or 5.5-8.0 cm, the staged approach is appropriate. If the AAA is tender and/or > 8.0 cm, a combined approach may be a better option in order to avoid the risk of AAA rupture during the in terval between the operations. Endolumenal repair of AAA offers a further o ption for the staged and combined approach, and may be less invasive than t he standard open surgery for AAA repair, (C) 2000 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.