Simultaneous coronary artery bypass grafting and peripheral revascularization in generalized atherosclerotic patients

Simultaneous coronary artery bypass grafting and peripheral revascularization in generalized atherosclerotic patients

Şebnem Çetemen Albeyoğlu, Uğur Filizcan, Bayer Çınar, Hakkı Aydoğan, Onur Göksel, Veysel Şahin, Murat Sargın, E. Ergin Eren

Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, İstanbul

Background: Angiographically documented coexistence of coronary artery disease (CAD) and peripheric artery disease is as frequent as 37% to 78%. Although the coexistence of carotid artery stenosis or abdominal aortic aneurysm with CAD is a more common clinical situation, the prevalence of severe aortailiac occlusive disease (AIOD) has been reported as 4% and 15% in different series of patients undergoing coronary artery bypass operation. Short term follow-up results of the combined surgical interventions in a group of complicated patients with heavily calcified ascending aorta, simultaneous critical AIOD, low ejection fraction and/or unstable angina pectoris were evaluated in the present study.

Methods: Eleven male patients (mean age 62.8), with severe CAD and coexisting critical AIOD were included in the study. All patients underwent cardiac catheterization, lower extremity arterial Doppler ultrasonography, abdominal computed tomography and magnetic resonance angiography. Simultaneous coronary bypass on the beating heart and extraanatomical peripheric arterial revascularization were performed to all patients.

Results: There were no neurologic, respiratory complications, cardiac or peripheral ischemia in any of the cases in the postoperative follow-up period. The follow-up period was 3.4 years and only one patient has been reoperated due to an occluded graft.

Conclusion: We conclude that in patients with a high risk profile, combined surgical approach consisting of offpump coronary bypass surgery and simultaneous extraanatomic peripheric revascularization, avoiding the manipulation of the heavily calcified ascending aorta, is a safe and preferrable approach.

Keywords : Arterial occlusive diseases; coronary artery bypass; vascular surgical procedures

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