For Debate: Concomitant Critical Coronary Arterial Disease and Abdominal Aortic Aneurysm — Timing of Corrective Procedures

Background. The high prevalence of coronary artery disease (CAD) in patients with abdominal aortic aneurysm (AAA) is responsible for most < 30-day mortality and morbidity in elective repair of AAA. The continuing debate regarding staged or combined surgery for AAA and CAD (coronary artery bypass grafting — CABG) in the small number of patients with critical degrees of both co-morbidities has not had a significant impact on the greater mortality and morbidity when the AAA repair is undertaken using the standard open operation. Patients. We report four cases with these combined pathologies which we have managed over the last 30 months during which time we have developed techniques of endolumenal repair of AAA. Conclusions. Whilst it is not possible to make firm recommendations regarding management strategy owing mainly to a lack of large series reporting this unusual combination of co-morbidities, the options are debated on the basis of published anecdotal evidence as well as our own case reports. We suggest that if the AAA is non-tender and/or 5.5–8.0 cm, the staged approach is appropriate. If the AAA is tender and/or > 8.0 cm, a combined approach may be a better option in order to avoid the risk of AAA rupture during the interval between the operations. Endolumenal repair of AAA offers a further option for the staged and combined approach, and may be less invasive than the standard open surgery for AAA repair.