Association of coronary artery disease and peripheral arterial disease in patients undergoing elective open abdominal aortic aneurysm repair

Abstract

Introduction: Open surgical repair of abdominal aortic aneurysm (AAA) is one of the commonest aortic surgeries performed in tertiary care vascular centres. As association of coronary artery disease (CAD) and peripheral arterial disease (PAD) is high in these patients, need for cardiac risk stratification with or without coronary intervention prior to surgery and its effect on long term survival benefit have been debated. In our institution, all patients who undergo elective aortic aneurysm surgery undergo diagnostic coronary angiogram. Intervention (Percutaneous Coronary Intervention or coronary artery bypass surgery) was performed prior to surgery, if patient was symptomatic/ had multiple critical occlusions in coronary vessels. We also looked into the prevalence of peripheral arterial disease in these patients. Methods: Single centre retrospective study. 199 patients who underwent elective aortic aneurysm repair in the last 10 years were studied. Data was collected from electronic and hospital medical records and analysed. Results: Significant CAD was seen in 105 patients (52.7%) out of which 40 patients (20.1%) underwent preoperative intervention while 65 patients (32.7%) underwent surgery without the same. Prevalence of significant CAD in AAA was high (52.7%) whereas PAD was seen in 26 patients (13.1%). Conclusion: We suggest it worthwhile to assess the coronary status in these patients preoperatively for risk stratification. Prophylactic coronary revascularization should be individualized and can prevent post-operative adverse cardiac events. Medical treatment for concomitant CAD with no obvious inducible ischemia does not confer unfavorable outcomes. Presence of PAD should not be overlooked and should be identified and intervened in the same setting if critical to decrease the morbidity.