Abstract
BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD) of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours). RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6%) of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.
Highlights
There is a high prevalence of Coronary ArteryDisease (CAD) among patients with Peripheral Arterial Occlusive Disease (PAOD) and in the majority of cases atherosclerosis is the cause of both conditions
All peripheral artery occlusive disease (PAOD) patients should undergo detailed preoperative cardiac assessment with the objective of identifying cases with concomitant myocardial ischemia. These assessments are important for patients with critical ischemia of the lower extremities (MMII) and for candidates for lower extremity revascularization surgery, because surgical stress, involving elevated catecholamine production, leading to tachycardia, vasoconstriction and myocardial hypoxia, increases their risk of acute myocardial infarction (AMI)[6,7,8,9,10,11] during the perioperative period
While the link between PAOD and Coronary ArteryDisease (CAD) has been definitively demonstrated in the literature, few studies have clearly established the incidence of postoperative AMI among infrainguinal revascularization patients
Summary
Disease (CAD) among patients with Peripheral Arterial Occlusive Disease (PAOD) and in the majority of cases atherosclerosis is the cause of both conditions These patients are considered high risk for surgery[1,2,3,4,5]. While the link between PAOD and CAD has been definitively demonstrated in the literature, few studies have clearly established the incidence of postoperative AMI among infrainguinal revascularization patients. Patients with PAOD often have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. Objective: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%
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