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

ABSTRACT

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.