Abdominal Aortic Aneurysm and Significant Coronary Artery Disease: Strategies and Options

OBJECTIVES: The optimal treatment for patients requiring intervention for coronary artery disease (CAD) and concomitant large or symptomatic abdominal aortic aneurysm (AAA) remains problematic. METHODS: Retrospective analysis was performed of 32 patients with symptomatic or large (> cm) AAA along with significant CAD treated over the past fifteen years at a university hospital. RESULTS: Mean AAA diameter was 6.6 cm. CAD involved 3 or more vessels in all patients. Fifteen patients underwent staged coronary artery bypass grafting (CABG) followed by open AAA repair, with two (13%) dying as a result of aneurysm rupture in the early postoperative period. No major complications were encountered among five patients receiving staged coronary angioplasty before open AAA repair and two patients undergoing staged CABG followed by endovascular aneurysm repair. Ten patients underwent concomitant CABG and AAA repair, with a single intraoperative death (10%). No differences in morbidity were observed among patients undergoing concomitant procedures as compared with those subjected to staged procedures. CONCLUSIONS: Minimally invasive interventions for coronary revascularization and aortic aneurysm repair appear to be safe and effective options in properly selected high-risk patients. While optimal management must be individualized, these data suggest that either staged or concomitant CABG and AAA repair may be viable options when minimally invasive interventions are not feasible.