Elsevier

Journal of Vascular Surgery

Volume 31, Issue 2, February 2000, Pages 253-259
Journal of Vascular Surgery

Repair of large abdominal aortic aneurysm should be performed early after coronary artery bypass surgery*,**,*

Presented at the Fifty-third Annual Meeting of The Society for Vascular Surgery, Washington, DC, Jun 6–9, 1999.
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Abstract

Purpose: The surgical repair (coronary artery bypass grafting [CABG]) of symptomatic coronary artery disease (CAD) in patients with co-existent large abdominal aortic aneurysm (AAA) may result in an increased rate of AAA rupture after operation. Simultaneous CABG/AAA repair has been recommended by some surgeons, but with a somewhat higher mortality rate than staged repair. We reviewed the outcome of staged AAA repair that was performed early after CABG in patients with symptomatic coronary disease and AAA. Methods: The records of all the patients with symptomatic CAD that required CABG with large AAA (greater than 5 cm) were reviewed. In most patients, CABG was performed first, followed by AAA repair within 2 weeks. Patient demographics, severity of coronary disease, AAA size, interprocedure duration, and perioperative morbidity and mortality rates were examined. Results: Between 1991 and 1998, 1105 AAA repairs were performed. Within this group, 30 patients with AAA underwent CABG for symptomatic CAD. Mean AAA size was 6.6 cm (range, 5.0-10.0 cm). The median interprocedure interval between CABG and AAA repair was 11.5 days. There was no in-hospital AAA rupture during this interval. The patient group was comprised of 24 men and 6 women with a mean age of 71 years. There was no operative death after such staged AAA repair, and nonfatal complications occurred in seven patients (23%). During this period, seven patients had AAA rupture when they were sent home after CABG for recovery and intended AAA repair at a later date. Conclusion: Staged elective AAA repair may be performed safely and effectively after CABG. Performance of these procedures with a short interprocedure interval may be preferable to the higher complication rate observed after combined procedures. (J Vasc Surg 2000;31:253-9.)

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*

Competition of interest: nil.

**

Reprint requests: Dr R. Clement Darling III, Vascular Institute (MC157), Albany Medical College, 47 New Scotland Ave, Albany, NY 12208.

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0741-5214/2000/$12.00 + 0  24/6/103235