The Arm Ergometer Exercise Test to Detect Ischemic Heart Disease in Arteriosclerosis Obliterans of the Lower Extremities and Surgical Management / 日本心臓血管外科学会雑誌

The arm ergometer exercise test (Arm E) was performed in 24 patients with arteriosclerosis obliterans of the lower extremities (ASO) to detect ischemic heart disease (IHD). All patients underwent coronary arteriography. IHD was detected in 16 patients (67%) with ASO. Sensitivity for diagnosis of IHD was 94%, specificity was 75% and accuracy was 88%. The severity of coronary artery disease was graded by the coronary score (CS) proposed by Leaman, et al. and the scores were compared with the mode of surgical treatment. In 3 patients with a CS between 16 and 22, the revascularization of both coronary arteries (CABG) and of peripheral arteries were performed in one stage. In 12 patients with CS below 5.5, only arterial revascularization of the lower extremities was performed without complications from the associated IHD. These results suggest that Arm E is a useful screening test to detect IHD in patients with ASO for surgery.

Surgical Management of Arteriosclerosis Obliterans of the Lower Extremities and Aortic Aneurysm in Patients with Ischemic Heart Disease / 日本心臓血管外科学会雑誌

Ischemic heart disease (IHD) poses some serious problems in the surgical treatment of arteriosclerosis obliterans of the lower extremities (ASO) and aortic aneurysm (AA). The surgical management of these vascular diseases in patients with IHD was evaluated. Thirty-five patients had ASO and 31 had AA. All patients underwent coronary arteriogram. IHD was detected in 24 patients (69%) with ASO and in 12 (39%) with AA. The severity of coronary artery disease was graded by the coronary score (CS) proposed by Leaman et al., and the scores were compared with the mode of surgical treatment. In patients with ASO, both the revascularization of coronary arteries (CABG) and of peripheral arteries were performed in one stage in 3 patients with a CS of 16-22. Only arterial revascularization of the lower extremities was performed in 19 patients with a CS of below 5.5. In AA, surgical treatment was performed with consideration of the severity of the coronary artery disease and the surgical approach. Both CABG and aortic reconstruction were performed in one stage in 3 patients with abdominal aortic aneurysm (CS: 9.5-13.5) and in 2 patients with aortic arch aneurysm (CS: 3.5, 8) with a coronary lesion in the left anterior descending branch (LAD). Only aortic repair was performed in 5 patients with a CS below 8 (without LAD lesion). The patients with ASO (CS≤5.5), and those with AA (CS≤8, no LAD lesion) underwent reconstruction only in the arteries of the lower extremities and aortic aneurysms, respectively, without any complications from the associated IHD.

Transesophageal Pacing for the Evaluation of Ischemic Heart Disease in Patients with Atheroscrelotic Vascular Disease / 日本心臓血管外科学会雑誌

Transesophageal pacing (TEP) was performed in 54 patients with atheroscrelotic vascular disease to detect ischemic heart disease (IHD). Thirty patients had arteriosclerosis obliterans of the lower extremities (ASO) and 24 patients aortic aneurysm (AA). All patients underwent coronary arteriography. Sensitivity for the diagnosis of IHD was 90% and the specificity 67%, accuracy 83% in ASO and sensitivity 80%, specificity 93%, accuracy 88% in AA. In both vascular diseases the sensitivity was 87%, the specificity was 83%, and the accuracy was 85%. These results suggest that TEP is a useful screening test to detect IHD in patients with atheroscrelotic vascular disease who are candidates for surgery.