In-hospital outcomes of endovascular abdominal aortic aneurysm repair after previous myocardial revascularization for coronary artery disease

Objective. To evaluate the effectiveness of preliminary myocardial revascularization in patients with coronary artery disease (CAD) undergoing endovascular abdominal aortic aneurysm (AAA) repair. Material and methods. A single-center retrospective study included 232 patients with CAD and AAA. Heart team determined feasibility, stages and details of surgical interventions. Patients were divided into 2 groups depending on myocardial revascularization strategy: group 1 — percutaneous transluminal angioplasty (PTA) with stenting as the first stage followed by endovascular aneurysm repair (EVAR) as the second stage (n=138; 59.5%); group 2 — coronary artery bypass grafting (CABG) at the first stage and EVAR at the second stage (n=94; 40.5%). We analyzed in-hospital results of EVAR in patients with AAA and CAD after previous myocardial revascularization. Results. Overall in-hospital mortality was 0.4% (group 1 — 0.7%, group 2 — 0). Incidence of perioperative ischemic events was 1.4% and 0%, respectively. We observed the following early postoperative adverse events: angina pectoris (n=1, 0.4%), myocardial infarction with fatal outcome (n=1, 0.4%), atrial fibrillation de novo (n=5, 2.2%), stent-graft thrombosis (n=4, 1.7%), stent-graft deformations requiring redo intervention (n=2, 0.9%), acute renal failure (n=5, 2.2%), endoleaks (n=42, 18.1%) including 3 (1.3%) severe ones requiring redo intervention (other endoleaks regressed within 6 months), pneumonia (n=2, 0.7%) and thromboembolic syndrome (n=1, 0.4%). Conclusion. Preliminary myocardial revascularization before EVAR in patients with coronary artery disease and abdominal aortic aneurysm (indications for intervention in two vascular territories) is characterized by low overall mortality rate (0.4%). However, further research is required. Risk of perioperative myocardial ischemia is slightly higher in patients with undergoing EVAR after previous PTA compared to CABG (p=0.241; RR=1.01; OR=3.46). The overall incidence of complications was lower after PTA compared to CABG (p<0.05; OR=0.75; OR=0.54).