Soma Y, Kawada K, Yozu R, Inoue T
Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1467-70.
In order to know how to treat the coronary artery disease in scheduled aortic surgery for aortic aneurysms, a prospective study started about ten years ago using routine coronary angiography (CAG). Thoracic aortic aneurysm (TAA): CAG was performed in 73 among 143 patients and 18 had significant coronary artery stenoses (CAD), 3 of whom had angina. Concomitant CABG was performed in 2 of 4 patients requiring coronary revascularization (CR) to prevent intraoperative myocardial ischemia. Complications due to CAD were experienced in the 2 patients without CR despite of angina, while patients without angina or with CR had no complication. Abdominal aortic aneurysm (AAA): Seventy six among 150 patients had CAG, and CAD was found in 38. CR was indicated to 5 of 7 patients with angina. Complications occurred in 2 patients who had not CR in spite of angina. Patients without angina had no complication.
为了了解如何在主动脉瘤的计划性主动脉手术中治疗冠状动脉疾病，大约十年前开始了一项使用常规冠状动脉造影（CAG）的前瞻性研究。胸主动脉瘤（TAA）：143例患者中有73例进行了CAG，18例有显著冠状动脉狭窄（CAD），其中3例有心绞痛。4例需要冠状动脉血运重建（CR）以预防术中心肌缺血的患者中有2例同时进行了冠状动脉旁路移植术（CABG）。尽管有2例有心绞痛但未进行CR的患者发生了CAD相关并发症，而无心绞痛或进行了CR的患者未发生并发症。腹主动脉瘤（AAA）：150例患者中有76例进行了CAG，发现38例有CAD。7例有心绞痛的患者中有5例需要CR。2例尽管有心绞痛但未进行CR的患者发生了并发症。无心绞痛的患者未发生并发症。
1）有心绞痛的患者因CAD发生并发症的风险高。2）有心绞痛且在动脉瘤切除术中需要心脏骤停的患者应在动脉瘤切除术前行冠状动脉血运重建。3）无心绞痛的患者在主动脉手术围术期发生心肌缺血的风险低。
