Islamoğlu F, Atay Y, Can L, Kara E, Ozbaran M, Yüksel M, Büket S
The Department of Cardiovascular Surgery, Ege University, Izmir, Turkey.
Tex Heart Inst J. 1999;26(3):182-8.
Coronary arteriosclerosis seriously complicates the surgical treatment of aortic diseases. The aim of our retrospective study was to determine the incidence of coronary artery disease among our surgical patients in treatment for aortic dissection or aneurysm, and to determine whether coronary intervention before aortic surgery appears to affect outcomes. Between 1 January 1993 and 1 March 1998, our center treated 253 patients for aortic dissection or aneurysm. We examined these cases retrospectively for information on diagnostic and treatment methods, both for the aortic lesions and for concomitant coronary arteriosclerosis. Aortic dissection had been detected in 86 (33.9%) patients and aortic aneurysm in 167 (66.1%). Coronary angiography was performed to search for concomitant coronary artery disease in 29 (33.8%) patients with dissection and in 112 (67.1%) patients with aneurysm; of these, 11 (12. 7%) and 54 (32.3%), respectively, were found to have coronary disease. Among 43 patients with abdominal aortic aneurysm in whom coronary angiography was performed, concomitant coronary disease was detected in 36 (83.7%). Coronary artery bypass surgery was performed in 10 patients who had dissection and in 30 patients who had aneurysm; percutaneous transluminal coronary angioplasty was performed in 7 patients who had aneurysm. Perioperative mortality rates in the dissection and aneurysm groups, overall, were 23.2% and 13.8%, respectively Unfortunately, the prospective, random clinical study that would be necessary to prove the case for or against preoperative coronary angiography among subsets of patients in need of aortic repair would raise ethical questions, given the strength of the information already in our possession, gathered by less formal methods. Our study reinforces existing evidence that preoperative angiography can reduce mortality and morbidity in the elective repair of aortic aneurysm, especially thoracic or abdominal aneurysm. However, angiography should not be performed routinely in cases of aortic dissection and should be withheld in cases of type A dissection.
冠状动脉硬化使主动脉疾病的外科治疗严重复杂化。我们这项回顾性研究的目的是确定在接受主动脉夹层或动脉瘤治疗的外科手术患者中冠状动脉疾病的发生率，并确定在主动脉手术前进行冠状动脉介入治疗是否似乎会影响治疗结果。在1993年1月1日至1998年3月1日期间，我们中心治疗了253例主动脉夹层或动脉瘤患者。我们对这些病例进行了回顾性检查，以获取有关主动脉病变及合并冠状动脉硬化的诊断和治疗方法的信息。86例（33.9%）患者被检测出主动脉夹层，167例（66.1%）患者被检测出主动脉瘤。对29例（33.8%）夹层患者和112例（67.1%）动脉瘤患者进行了冠状动脉造影以寻找合并的冠状动脉疾病；其中，分别有11例（12.7%）和54例（32.3%）被发现患有冠状动脉疾病。在43例接受冠状动脉造影的腹主动脉瘤患者中，36例（83.7%）被检测出合并冠状动脉疾病。10例夹层患者和30例动脉瘤患者接受了冠状动脉搭桥手术；7例动脉瘤患者接受了经皮腔内冠状动脉成形术。总体而言，夹层组和动脉瘤组的围手术期死亡率分别为23.2%和13.8%。遗憾的是，鉴于我们已经通过不太正规的方法收集到的信息的力度，要对需要主动脉修复的患者亚组进行支持或反对术前冠状动脉造影的前瞻性随机临床研究将会引发伦理问题。我们的研究强化了现有证据，即术前血管造影可以降低主动脉瘤择期修复手术中的死亡率和发病率，尤其是胸主动脉瘤或腹主动脉瘤。然而，在主动脉夹层病例中不应常规进行血管造影，对于A型夹层病例应避免进行血管造影。
