[Strategy of the surgical approach to combined coronary and peripheral atherosclerosis].
The aim of this study is to compare the results of one stage surgical treatment of combined multifocal aortoiliac (AIOD) and coronary (CA) atherosclerosis (ATS) with two staged surgical approach and isolated aortoiliac reconstructions and to determine adequate surgical strategy for this combination of ATS. The study includes 104 patients (pts) with different localization of multifocal ATS (predominately AIOD and CA) divided in three groups according to the type of operative procedure: Group A--64 with AIOD operated only for this pathology (aortobifemoral bypass grafting-Ao2F) since CA didn't necessitate operative treatment. Group B--30 pts. with combined multifocal AIOD and coronary atherosclerosis were operated in one stage (coronary artery bypass grafting-CABG and Ao2F). Group C--10 pts. with combined multifocal AIOD and coronary atherosclerosis were operated in two stages (CABG first and 4-12 months later Ao2F). Postoperative clinical improvement was obtained in 90% of the pts in all three groups which proved effectiveness both of Ao2F and CABG performed in one or two stages or isolated. There was not significant difference in vascular complications and mortality in pts. of the three groups. Our experience and clinical data in this study dictated that one stage combined operative treatment of AIOD and coronary atherosclerosis is recommendable only in cases of: 1. Critical limb ischemia (III-IV st. of Fontaine) when vascular reconstruction is indicated to avoid development of limb gangrene at the time of cardiopulmonary bypass. 2. In cases when ejection fraction (EF) is < 30% and introduction of Intraaortic-balloon pump is indicated, simultaneous performance of CABG and Ao2F is presenting best conditions this procedure. In the absence of this specific indications two staged surgical approach seems more favorable--CABG first and Ao2F some months later.
Zakhariev
T
T
Grozdinski
D
D
Stankev
M
M
Nachev
G
G
Chirkov
A
A
D001161:Arteriosclerosis / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods* / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged