IMPACT OF CARDIAC RISK FACTORS ON TREATMENT STRATEGY FOR PATIENTS WITH CORONARY ARTERY DISEASE AND AORTOILIAC LESIONS
https://doi.org/10.17802/2306-1278-2013-4-77-82
Abstract
Purpose. To assess the impact of cardiac risk factors on the treatment strategy for patients with multiple atherosclerotic lesions.
Materials and methods. The study presented the results of the treatment of 97 patients with aortoiliac lesions and coronary artery disease. 51 patients had infrarenal aortic aneurysm and 46 patients were diagnosed with chronic lower limb ischemia. All the patients had ECG, echocardiography and coronary angiography performed. The additional studies performed were Holter and blood pressure monitoring, stress echo and thallium myocardial perfusion scintigraphy.
Results. Open-heart myocardial revascularization as the first stage procedure was done in 10 aneurysm patients and 8 lower limb ischemia patients, transluminal balloon angioplasty (PTCA) with stenting was done in 12 and 11 patients, respectively. Aortoiliac lesions were treated during the second-stage procedure. After the interventions for aortic lesions there was one death in the abdominal aortic aneurysm group; the lower limb ischemia group had no fatal outcomes.
Conclusions. 1.Most patients with abdominal aortic aneurysms and chronic ischemia have significant cardiac risk factors with coronary artery lesions being the leading one. 2. Coronary angiography remains the most accurate technique for coronary lesion assessment. 3. Patients with severe coronary lesions require myocardial revascularization (coronary artery bypass surgery, stenting) as the first-stage procedure. 4. In patients at a high risk of cardiac complications the surgery for abdominal aortic aneurysms or chronic lower limb ischemia can be performed only if there exist life-saving indications.
About the Authors
V. S. Arakelyan
Federal State Budgetary Institution Bakoulev Center for Cardiovascular Surgery
Russian Academy of Medical Sciences, Moscow
Russian Federation
of Institution of coronary and vascular surgery, Dr. Med. Sci.; 8, Bldg. 7, Leninskiy prospect, Moscow, 117931
Russian Federation
of Institution of coronary and vascular surgery, Dr. Med. Sci.; 8, Bldg. 7, Leninskiy prospect, Moscow, 117931
N. V. Bortnikova
Federal State Budgetary Institution Bakoulev Center for Cardiovascular Surgery
Russian Academy of Medical Sciences, Moscow
Russian Federation
Russian Federation
V. G. Papitashvili
Federal State Budgetary Institution Bakoulev Center for Cardiovascular Surgery
Russian Academy of Medical Sciences, Moscow
Russian Federation
Russian Federation
References
1. Дуданов И . П. Хирургическое лечение сочетанных атеросклеротических поражений брахиоцефальных артерий и брюшной аорты: автореф. дис. ... д-ра мед. наук, СПб., 1993. 36 с.
2. Влияние кардиального статуса и артериальной гипертензии на результаты хирургического лечения больных с аневризмами брюшной аорты старше 70 лет / А. В. Покровский [и др.] // Ангиология и сосудистая хирургия. 2003. № 1. С. 71–76.
3. Казанчян П. О ., Попов В . А . Осложнения в хирургии аневризм брюшной аорты. М.: Изд-во МЭИ, 2002. 304 с.
4. Спиридонов А . А ., Тутов Е . Г ., Аракелян В . С. Хирургическое лечение аневризм брюшной аорты. М.: Изд-во НЦ ССХ им. А. Н. Бакулева РАМН, 2000. 206 с.
5. Этапные и одномоментные операции реваскуляризации головного мозга и миокарда у больных ишемической болезнью сердца с поражением брахиоцефальных артерий / В. С. Работников [и др.] // Анналы хирургии. 1999. № 6. С. 36–40.
6. Combined coronary artery bypass graft and abdominal aortic aneurysmectomy / M. Garcia [et al.] // J. Heart Surg. 1983. Vol. 10(2). P. 125–130.
7. Current outcome of abdominal aortic aneurysm repair / S. Rinckenbach [et al.] // Ann. Vasc. Surg. 2004. Vol. 18(6). P. 704–709.
8. El-Sabrout R. A., Reul G. J., Colley D. A. Outcome after simultaneous abdominal aortic aneurysm repair and aortocoronary bypass // Ann. Vasc. Surg. 2002. Vol. 16(3). P. 321–330.
9. Influence of coronary artery disease on morbidity and mortality after abdominal aortic aneurysmectomy: a populationbased study, 1971–1987 / V. L. Roger [et al.] // J. Am. Coll. Cardiol. 1989. Vol. 14. P. 1245–1252.
10. Infrarenal abdominal aortic aneurysm: factors influencing survival after operation performed over a 25-year period / E. S. Crawford [et al.] // Ann. Surg. 1981. Vol. 193. P. 699–709.
11. Limitations in the cardiac risk reduction provided by coronary revascularization prior to elective vascular surgery / M. R. Back [et al.] // J. Vasc. Surg. 2002. Vol. 36(3). P. 644–645.
12. Optimal timing of abdominal aortic aneurysm repair after coronary revascularization / L. H. Blackbourne [et al.] // Ann. Surg. 1994. Vol. 219. P. 693–698.
13. Predictors of death in nonruptured and ruptured abdominal aortic aneurysms / J. C. Chen [et al.] // J. Vasc. Surg. 1996. Vol. 24(4). P. 614–620.
14. The impact of coronary revascularization on long-term outcomes after surgical repair of abdominal aortic aneurysm / M. Garofalo [et al.] // Ital. Heart J. 2005. Vol. 6(6). P. 369–374.
Review
For citations:
Arakelyan V.S., Bortnikova N.V., Papitashvili V.G. IMPACT OF CARDIAC RISK FACTORS ON TREATMENT STRATEGY FOR PATIENTS WITH CORONARY ARTERY DISEASE AND AORTOILIAC LESIONS. Complex Issues of Cardiovascular Diseases. 2013;(4):77-82. (In Russ.) https://doi.org/10.17802/2306-1278-2013-4-77-82
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