Combined Coronary Artery Bypass and Open Repair of Abdominal Aortic Aneurysm

Abstract

The coexistence of symptomatic abdominal aortic aneurysm (AAA) and coronary artery disease (CAD) is not uncommon. In most cases, coronary revascularization with angioplasty or bypass (CABG) is performed before AAA repair to reduce the risk of cardiac morbidity. The purpose of this was to review the management of patients with symptomatic large AAA and coronary artery disease. A retrospective chart review of two patients with symptomatic coronary artery disease and >9 cm AAA managed using a combined approach. A 60-year-old man presented with a 9.2 centimeter AAA and severe CAD and a 73-year-old man with a 9.0-centimeter AAA. Both patients underwent combined CABG and open AAA repair. Operative times were 400 and 373 minutes, respectively. Neither experienced any postoperative complications, such as renal failure, respiratory failure, bleeding, or infection, despite a number of medical comorbidities and decades of tobacco use. Both men are alive and well at 8 and 9 years respectively. In special circumstances, patients with large AAA and severe CAD can be considered for combined repair. We report two such cases treated successfully with excellent long-term results.