Simultaneous Surgical Treatment Of Patients With Abdominal Aortic Aneurysm And Concomitant Ischemic Heart Disease

Abstract

Controversy exists over the optimal management of patients with both symptomatic cardiac disease and significant abdominal aortic aneurysm (AAA), unsuitable for endovascular treatment for either pathology. We present our experience in 36 cases of simultaneous one-stage coronary and open AAA repair during the period 1990-2009. Analysis of the performed surgical procedures showed that in 13 patients (36,1%) we used a tube graft for the repair of the AAA, in 17 patients (47,2%) – aorto-bifemoral/biprofunda bypass, 6 patients (16,7%) – aorto-biiliac bypass. The aorto-coronary bypass most frequently involved revascularization of 3 coronary arteries (18 patients, 50,0%), 2 coronary arteries (15 patients, 41,7%), 4 coronary arteries (3 patients, 8,3%). In the early postoperative period we had 3 cases (8,3%) of myocardial infarction and 2 cases of stroke (5,6%). In another 2 patients (5,6%) severe complications lead to death. In conclusion, when managed within a multidisciplinary team setting and with careful case selection, combined cardiac and open AAA surgery may be carried out with acceptable mortality and morbidity in order to circumvent the risk of fatal AAA rupture.