Associated vascular lesions in patients undergoing coronary artery bypass grafting

Atherosclerotic involvement of extracoronary arteries in patients undergoin g myocardial revascularization can cause severe postoperative complications and increase postoperative mortality. Between January and November 1998, routine preoperative echo-Doppler study of carotid vessels, abdominal aorta and iliac-femoral arteries was performe d in all patients undergoing coronary artery bypass grafting (CABG) at our institution, in order to assess the prevalence and the degree of associated vascular lesions. Correlations between echo-Doppler findings, angiographic patterns of coronary lesions and atherosclerotic risk factors were analyze d in all cases. Among 302 patients undergoing CABG, 186 (61.6%) had carotid disease, with a haemodynamically significant stenosis (> 70%) of internal carotid in 31 (1 0.2%). Twenty-three patients had asymptomatic severe carotid disease. A sig nificant correlation between severity of coronary disease and prevalence of severe carotid disease was found (p = 0.02), An abdominal aortic dilatation (diameter > 25 mm) was found in 20 cases (6. 6%), with a diameter > 35 mm in 7 patients (2.3%), 6 with triple-vessel cor onary disease, and I with double-vessel disease. Atherosclerotic lesions of iliac-femoro-popliteal axis were found in 165 (54.6%) patients, with a str ong correlation to the severity of coronary disease (p = 0.02); lesions wer e haemodynamically significant (> 70%) in 48 (15.8%) cases, Symptoms of carotid and peripheral vascular disease are no reliable predict ors of perioperative risk in patients undergoing CABG, Non-invasive complet e arterial investigation should be routinely performed in these patients, i n order to plan the most suitable operative approach and to prevent periope rative vascular complications.