title: Diagnostic coronary angiography in patients with peripheral arterial disease: a sub-study of the Coronary Artery Revascularization Prophylaxis Trial.
abstract: BACKGROUND
  Although patients in need of elective vascular surgery are often considered candidates for diagnostic coronary angiography, the safety of this invasive study has not been systematically studied in a large cohort of patients scheduled for an elective vascular operation. The goal of this sub-study of the Coronary Artery Revascularization Prophylaxis (CARP) trial was to assess the safety of coronary angiography in patients with peripheral vascular disease.
  
  
  METHODS
  The CARP trial tested the long-term benefit of coronary artery revascularization prior to elective vascular operations. Among those patients who underwent diagnostic coronary angiography during screening for the trial, the associated complications were determined at 24 hours following the diagnostic procedure.
  
  
  RESULTS
  Over 5,000 patients were screened during a 4-year recruitment period at 18 major VA medical centers and the present cohort consists of 1,298 patients who underwent preoperative coronary angiography. Surgical indications for vascular surgery included an expanding aortic aneurysm (AAA) (n = 446; 34.4%) or arterial occlusive disease with either claudication (n = 457; 35.2%) or rest pain (n = 395; 30.4%). A total of 39 patients had a confirmed complication with a major complication identified in 17 patients (1.3%). Complication rates were higher in patients with arterial occlusive symptoms compared with expanding aneurysms (1.8% vs. 0.5%; P = 0.07) and were not dissimilar with femoral (2.8%) versus nonfemoral (4.7%) access sites (P = 0.42).
  
  
  CONCLUSIONS
  Coronary angiography is safe in patients with peripheral arterial disease undergoing preoperative coronary angiography. The complication rate is higher in patients with symptoms of arterial occlusive disease.
authors.affiliation: Minneapolis Veterans Affairs Medical Center and the University of Minnesota, Minneapolis, MN 55417, USA.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.forename: Edward O
authors.initials: EO
authors.lastname: McFalls
authors.forename: Steven
authors.initials: S
authors.lastname: Goldman
authors.forename: Greg C
authors.initials: GC
authors.lastname: Larsen
authors.forename: Fred
authors.initials: F
authors.lastname: Littooy
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Moritz
authors.forename: Domenic J
authors.initials: DJ
authors.lastname: Reda
authors.forename: Herbert B
authors.initials: HB
authors.lastname: Ward
authors.forename: Kendrick
authors.initials: K
authors.lastname: Shunk
authors.forename: Brack
authors.initials: B
authors.lastname: Hattler