Hirooka Y, Tahara M, Kikuchi N, Sasaguri S, Yamamoto S, Yamamoto K, Watanabe M, Ohse Y, Tanaka A, Hosoda Y
Department of Thoracic Surgery, Juntendo University, School of Medicine, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Jun;39(6):891-4.
To determine the priority of the surgical treatment of coexistent aortic and coronary disease (CAD), we reviewed 19 cases of aortic aneurysm combined with severe coronary lesions who underwent operation from Jan, 1984 to Aug, 1989. There were 15 cases of abdominal and 4 cases of thoracic aneurysm. All patients had graft replacement for the aneurysm and 12 patients had elective aortocoronary bypass surgery (CABG), one had percutaneous transluminal coronary angioplasty and 6 received medical treatment for CAD. In 6 cases, CABG preceded abdominal aneurysm operation. In 3 cases of ascending thoracic aneurysm, simultaneous coronary and aortic operation were performed. There were no early and late operative death. In an attempt to reduce perioperative myocardial infarction which is one of the most frequent complications of aneurysmal operation, we performed routine coronary angiogram before operation. In 104 patients considered for elective aortic and peripheral vascular disease, coronary angiogram were performed. The incidence of coexistent coronary artery disease in peripheral vascular and aortic disease were 46.1%. The incidence of multiple vessel CAD in patients with aortic and peripheral disease were high. Our surgical strategy for coexistent aortic, peripheral vascular and coronary disease is basically staged operation and simultaneous operation are performed only in ascending and proximal arch aneurysm.
为确定主动脉疾病与冠状动脉疾病（CAD）并存时外科治疗的优先顺序，我们回顾了1984年1月至1989年8月期间接受手术治疗的19例主动脉瘤合并严重冠状动脉病变的病例。其中腹主动脉瘤15例，胸主动脉瘤4例。所有患者均接受了动脉瘤移植置换术，12例患者接受了择期主动脉冠状动脉搭桥术（CABG），1例接受了经皮腔内冠状动脉成形术，6例接受了CAD药物治疗。6例患者在腹主动脉瘤手术前进行了CABG。3例升主动脉瘤患者同时进行了冠状动脉和主动脉手术。无早期和晚期手术死亡。为减少围手术期心肌梗死（动脉瘤手术最常见的并发症之一），我们在手术前常规进行冠状动脉造影。在104例考虑择期进行主动脉和外周血管疾病手术的患者中进行了冠状动脉造影。外周血管和主动脉疾病中并存冠状动脉疾病的发生率为46.1%。主动脉和外周疾病患者中多支冠状动脉病变的发生率较高。我们对于主动脉、外周血管和冠状动脉疾病并存的外科治疗策略基本是分期手术，仅在升主动脉和主动脉弓近端动脉瘤患者中进行同期手术。
