Her Keun, Choi Changwoo, Park YoungWoo, Shin Hwakyun, Won YongSoon
Department of Thoracic and Cardiovascular Surgery, Armed Force Capital Hospital, Gyeonggi-do, Republic of Korea.
Ann Vasc Surg. 2008 Sep;22(5):649-56. doi: 10.1016/j.avsg.2008.01.010. Epub 2008 May 27.
The present study examines the use of routine coronary angiography (CAG) before elective peripheral artery disease (PAD) surgery and the early outcome and technical features of simultaneous coronary revascularization and PAD surgery in PAD patients with asymptomatic coronary artery disease (CAD). We performed preoperative CAG in 82 patients who were undergoing elective peripheral arterial bypass surgery and who had no diagnosis or symptoms of ischemic heart disease. The 82 patients were grouped according to the criteria of <70% stenosis, >70% stenosis, and no coronary stenosis. In patients with >70% coronary artery stenosis, we performed simultaneous peripheral artery bypass surgery and coronary artery bypass grafting (CABG), while the other patients underwent peripheral artery bypass only. Preoperative coronary angiography revealed CAD in 69.5% (n = 57) of patients. Patients with CAD were more likely to be older, hypertensive, and diabetic than patients without CAD (all p < 0.05). Preoperative electrocardiography showed that only 3/57 (5.3%) patients with CAD had ischemic heart disease. Of the 61 patients who underwent peripheral artery bypass, 27 (47.4%) underwent simultaneous CABG. Of the patients with CAD, 78.9% (45/57) required peripheral artery bypass, whereas 64.0% (16/25) of patients without CAD required peripheral artery bypass (p = 0.11). Comparing simultaneous CABG and peripheral artery bypass in PAD patients with CAD and isolated peripheral artery bypass in PAD patients regardless of CAD, the only significant difference was in operating time (362.00 +/- 79.18 vs. 246.55 +/- 79.15 min, p = 0.00). When compared with PAD patients with CAD who underwent isolated peripheral artery bypass, the results were similar. Two patients who had CAD and underwent isolated peripheral artery bypass died (p = 0.16). Patients with peripheral arterial obstructive disease should be examined for CAD using CAG, regardless of whether they have symptomatic ischemic heart disease, and simultaneous CABG and peripheral artery bypass is safe and feasible.
本研究探讨了在择期外周动脉疾病（PAD）手术前进行常规冠状动脉造影（CAG）的情况，以及无症状冠状动脉疾病（CAD）的PAD患者同时进行冠状动脉血运重建和PAD手术的早期结局及技术特点。我们对82例接受择期外周动脉搭桥手术且无缺血性心脏病诊断或症状的患者进行了术前CAG。这82例患者根据狭窄程度<70%、>70%和无冠状动脉狭窄的标准进行分组。在冠状动脉狭窄>70%的患者中，我们同时进行了外周动脉搭桥手术和冠状动脉搭桥术（CABG），而其他患者仅接受外周动脉搭桥手术。术前冠状动脉造影显示69.5%（n = 57）的患者存在CAD。与无CAD的患者相比，CAD患者更可能年龄较大、患有高血压和糖尿病（所有p<0.05）。术前心电图显示，57例CAD患者中只有3例（5.3%）患有缺血性心脏病。在61例行外周动脉搭桥手术的患者中，27例（47.4%）同时进行了CABG。在CAD患者中，78.9%（45/57）需要进行外周动脉搭桥，而无CAD患者中64.0%（16/25）需要进行外周动脉搭桥（p = 0.11）。比较CAD的PAD患者同时进行CABG和外周动脉搭桥与无论有无CAD的PAD患者单纯进行外周动脉搭桥，唯一显著的差异在于手术时间（362.00±79.18 vs. 246.55±79.15分钟，p = 0.00）。与单纯进行外周动脉搭桥的CAD的PAD患者相比，结果相似。2例患有CAD且单纯进行外周动脉搭桥的患者死亡（p = 0.16）。外周动脉阻塞性疾病患者无论是否有症状性缺血性心脏病，均应使用CAG检查是否存在CAD，同时进行CABG和外周动脉搭桥是安全可行的。
