Weisel R D
Can J Surg. 1987 Jul;30(4):237-9.
Coronary artery disease accounts for more than half of the morbidity and mortality associated with abdominal aortic surgery. To improve the results of vascular surgery, the risk of perioperative cardiac ischemia should be evaluated in each patient. Routine coronary angiography demonstrated severe correctable coronary artery disease in 14% of patients who had no history or electrocardiographic evidence of coronary artery disease. Exercise testing before abdominal aortic aneurysm repair will identify patients at high risk of cardiac ischemia. Dipyridamole-thallium imaging will identify high-risk patients before surgery for aortoiliac occlusive disease. Some patients with symptomatic coronary disease who are at extremely high risk should undergo preoperative coronary revascularization. Others should have their vascular surgery deferred, because their cardiac risk may exceed the anticipated benefit of the vascular surgery. Patients at moderate risk may need more intensive intraoperative monitoring. Patients without evidence of cardiac ischemia with stress may undergo vascular surgery with a low risk of perioperative cardiac ischemia. Finally, patients who have evidence of ischemic heart disease should be considered for coronary revascularization following successful vascular repair in order to prolong their survival.
冠状动脉疾病占腹主动脉手术相关发病率和死亡率的一半以上。为提高血管手术的效果，应评估每位患者围手术期心脏缺血的风险。常规冠状动脉造影显示，在无冠状动脉疾病病史或心电图证据的患者中，14%存在严重的可纠正冠状动脉疾病。腹主动脉瘤修复术前的运动试验将识别出心脏缺血高危患者。双嘧达莫 - 铊显像将在主髂动脉闭塞性疾病手术前识别出高危患者。一些有症状的冠状动脉疾病且风险极高的患者应接受术前冠状动脉血运重建。其他患者应推迟血管手术，因为他们的心脏风险可能超过血管手术预期的益处。中度风险的患者可能需要更强化的术中监测。无应激性心脏缺血证据的患者进行血管手术时围手术期心脏缺血风险较低。最后，有缺血性心脏病证据的患者在血管修复成功后应考虑进行冠状动脉血运重建，以延长生存期。
