Coronary and carotid artery disease in patients with degenerative aneurysm of the descending thoracic or thoracoabdominal aorta: prevalence and impact on operative mortality.

From January 1, 1995 to July 31, 2000, a total of 133 patients underwent elective surgical treatment for degenerative aneurysm of the descending thoracic (n = 45) or thoracoabdominal (n = 88) aorta. There were 116 men (87%) and 17 women (13%) with a mean age of 66.4 +/- 8.7 years (range, 39 to 84 years). Sixteen patients (12%) died in the immediate postoperative period. Thirteen patients (10%) had already undergone myocardial revascularizaton. Thirty-five patients (26%) presented clinical symptoms of coronary artery disease. Preoperative coronary arteriography was performed in 84 (63%) patients, demonstrating normal findings or clinically insignificant lesions in 48 patients (57%), single-vessel lesions (>70% reduction in diameter) in 19 patients, two-vessel lesions in 12 patients, and three-vessel lesions in 5 patients. On the basis of these findings, myocardial revascularization was performed before aortic repair in 11 patients. The total number of myocardial revascularization procedures in this series was 24 (18%). Four patients had previously undergone a total of 6 carotid endarterectomy procedures. Routine duplex ultrasound demonstrated significant carotid artery lesions in 12 patients (9%). Ten of these patients (8%) underwent carotid endarterectomy. The total number of carotid endarterectomy procedures in this series was 16 in 14 patients. The prevalence of coronary and carotid lesions in patients indicated for elective treatment for degenerative aneurysm of the descending thoracic or thoracoabdominal aorta was similar to that observed in patients presenting degenerative aneurysm of the infrarenal abdominal aorta. Univariate analysis demonstrated that coronary and carotid lesions with or without treatment are a significant risk factor for mortality following surgical repair of degenerative aneurysm of the descending thoracic or thoracoabdominal aorta. This finding suggests that routine preoperative coronary arteriography and duplex ultrasound are warranted.