Routine coronary angiography in patients undergoing surgery for abdominal aortic aneurysm and lower extremity occlusive disease.

Between 1978 and 1982, 1000 patients under consideration for peripheral vascular reconstruction underwent coronary angiography. Normal coronary arteries were found in 8%; mild to moderate coronary artery disease (CAD), in 32%; advanced but compensated CAD, in 29%; severe correctable CAD, in 25%; and inoperable CAD, in 6%. Severe correctable CAD was demonstrated in 14% of patients who had no indications of CAD on clinical criteria. Patients with severe correctable CAD were advised to undergo myocardial revascularization before the vascular operation. Under this protocol, a total of 1292 cardiac and peripheral vascular reconstructions were performed with an overall mortality rate of 2.6% (5.2% for myocardial revascularization and 2% for vascular operation). Only one death (0.8%) occurred after peripheral vascular reconstruction in 130 patients who had preliminary myocardial revascularization. These results indicate that approximately 30% of all patients who require vascular reconstruction have severe, but surgically correctable, CAD and that preliminary myocardial revascularization appears to add a margin of safety to the subsequent vascular operation.