Role of coronary angiography and coronary artery bypass surgery prior to abdominal aortic aneurysmectomy.

It is well recognized that patients with abdominal aortic aneurysms have a high incidence of coronary artery disease, and that the major cause of death in patients undergoing aneurysmectomy has been acute myocardial infarction. In order to assess the incidence of significant coronary artery disease, cardiac catheterization was performed on 42 consecutive patients with abdominal aortic aneurysms. Thirty-six patients (85.7%) had significant anatomic coronary artery disease. Interestingly, all 8 patients with ejection fractions of less than 50% had triple vessel disease or left main disease, and 12 of 34 patients with ejection fractions greater than or equal to 50% had triple vessel disease or left main disease. Of the 30 patients who were NYHA Class I or Class II, 14 (46.7%) had triple vessel disease or left main disease. All 20 patients with triple vessel disease or left main disease underwent myocardial revascularization 7 to 10 days prior to abdominal aneurysmectomy. No patients had a perioperative myocardial infarction either following coronary artery bypass surgery or abdominal aortic aneurysm resection, and there were no operative mortalities. Although this was not a randomized study, it would seem from these results that in selected patients, myocardial revascularization prior to abdominal aneurysmectomy can decrease the incidence of acute myocardial infarction and also decrease operative mortality. It is presently recommended that all symptomatic patients, patients with ejection fractions of less than 50%, and asymptomatic patients with ejection fractions of greater than or equal to 50% with positive exercise radionuclide angiography undergo cardiac catheterization prior to aneurysmectomy, and those patients with left main disease or severe coronary artery disease undergo myocardial revascularization prior to aneurysm resection.