Concomitant peripheral artery disease and asymptomatic coronary artery disease: A management strategy

The present study examines the use of routine coronary angiography (CAG) before elective peripheral artery disease (PAD) surgery and the early outcome and technical features of simultaneous coronary revascularization and PAD surgery in PAD patients with asymptomatic coronar artery disease (CAD). We performed preoperative CAG in 82 patients who were undergoing elective peripheral arterial bypass surgery and who had no diagnosis or symptoms of ischemic heart disease. The 82 patients were grouped according to the criteria of < 70% stenosis > 70% stenosis and no coronary stenosis. In patients with > 70% coronary artery stenosis we performed simultaneous peripheral artery bypass surgery and coronary artery bypass grafting (CABG) while the other patients underwent peripheral artery bypass only. Preoperative coronary angiography revealed CAD in 69.5% (n = 57) of patients. Patients with CAD were more likely to be older hypertensive and diabetic than patients without CAD (all p < 0.05). Preoperative electrocardiography showed that only 3/57 (5.3%) patients with CAD had ischemic heart disease. Of the 61 patients who underwent peripheral artery bypass 27 (47.4%) underwent simultaneous CABG. Of the patients with CAD 78.9% (45/57) required peripheral artery bypass whereas 64.0% (16/25) of patients without CAD required peripheral artery bypass (p 0.11). Comparing simultaneous CABG and peripheral artery bypass in PAD patients with CAD and isolated peripheral artery bypass in PAD patients regardless of CAD the only significant difference was in operating time (362.00 +/- 79.18 vs. 246.55 +/- 79.15 min p = 0.00). When compared with PAD patients with CAD who underwent isolated peripheral artery bypass the results were similar. Two patients who had CAD and underwent isolated peripheral artery bypass died (p = 0.16). Patients with peripheral arterial obstructive disease should be examined for CAD using CAG regardless of whether they have symptomatic ischemic heart disease and simultaneous CABG and peripheral artery bypass is safe and feasible.