In-hospital outcomes of endovascular abdominal aortic aneurysm repair after previous myocardial revascularization for coronary artery disease

Close metadata

OBJECTIVE

To evaluate the effectiveness of preliminary myocardial revascularization in patients with coronary artery disease (CAD) undergoing endovascular abdominal aortic aneurysm (AAA) repair.

MATERIAL AND METHODS

A single-center retrospective study included 232 patients with CAD and AAA. Heart team determined feasibility, stages and details of surgical interventions. Patients were divided into 2 groups depending on myocardial revascularization strategy: group 1 — percutaneous transluminal angioplasty (PTA) with stenting as the first stage followed by endovascular aneurysm repair (EVAR) as the second stage (n=138; 59.5%); group 2 — coronary artery bypass grafting (CABG) at the first stage and EVAR at the second stage (n=94; 40.5%). We analyzed in-hospital results of EVAR in patients with AAA and CAD after previous myocardial revascularization.

RESULTS

Overall in-hospital mortality was 0.4% (group 1 — 0.7%, group 2 — 0). Incidence of perioperative ischemic events was 1.4% and 0%, respectively. We observed the following early postoperative adverse events: angina pectoris (n=1, 0.4%), myocardial infarction with fatal outcome (n=1, 0.4%), atrial fibrillation de novo (n=5, 2.2%), stent-graft thrombosis (n=4, 1.7%), stent-graft deformations requiring redo intervention (n=2, 0.9%), acute renal failure (n=5, 2.2%), endoleaks (n=42, 18.1%) including 3 (1.3%) severe ones requiring redo intervention (other endoleaks regressed within 6 months), pneumonia (n=2, 0.7%) and thromboembolic syndrome (n=1, 0.4%).

CONCLUSION

Preliminary myocardial revascularization before EVAR in patients with coronary artery disease and abdominal aortic aneurysm (indications for intervention in two vascular territories) is characterized by low overall mortality rate (0.4%). However, further research is required. Risk of perioperative myocardial ischemia is slightly higher in patients with undergoing EVAR after previous PTA compared to CABG (p=0.241; RR=1.01; OR=3.46). The overall incidence of complications was lower after PTA compared to CABG (p<0.05; OR=0.75; OR=0.54).

Keywords:

abdominal aortic aneurysm

coronary artery disease

endovascular aneurysm repair

myocardial revascularization

Authors:

Akchurin R.S.

Chazov National Medical Research Center of Cardiology

ORCID: 0000-0002-6726-4612

Shiryaev A.A.

Chazov National Medical Research Center for Cardiology

ORCID: 0000-0002-3325-9743

Imaev T.E.

Chazov National Medical Research Centre of Cardiology

ORCID: 0000-0002-5736-5698

Merkulov E.V.

Chazov National Medical Research Center of Cardiology

ORCID: 0000-0001-8193-8575

Latypov R.S.

Chazov National Medical Research Center of Cardiology

ORCID: 0000-0002-1652-7232

Lepilin P.M.

Chazov National Medical Research Center of Cardiology

ORCID: 0000-0003-2979-2542

Petrovskii D.V.

Chazov National Medical Research Center of Cardiology

ORCID: 0000-0001-8193-8575

Zadoia A.N.

Chazov National Medical Research Center of Cardiology

ORCID: 0009-0007-0587-7193

Received:

30.06.2023

Accepted:

10.08.2023

List of references:

Jensen RV, Hjortbak MV, Bøtker HE. Ischemic heart disease: an update. Elsevier. 2020;195-207.
Lee B-K, Lim H-S, Fearon WF, Yong AS, Yamada R, Tanaka S, Lee DP, Yeung AC, Tremmel JA. Invasive evaluation of patients with angina in the absence of obstructive coronary artery disease. Circulation. 2015;131(12):1054-1060. https://doi.org/10.1053/j.semnuclmed.2020.02.007
Serruys PW, Onuma Y, Garg S, et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention. 2009;5(1):50-56.
Gallino A, Aboyans V, Diehm C, Cosentino F, Stricker H, Falk E, Schouten O, Lekakis J, Amann-Vesti B, Siclari F, Poredos P, Novo S, Brodmann M, Schulte K-L, Vlachopoulos C, De Caterina R, Libby P, Baumgartner I; European Society of Cardiology Working Group on Peripheral Circulation. Non-coronary atherosclerosis. European Heart Journal. 2014;35(17):1112-1119. https://doi.org/10.1093/eurheartj/ehu071
Charchan ER, Stepanenko AB, Gens AP. Clinical Management of Patients With Abdominal Aortic Aneurysms Combined With Coronary Artery Disease and Multifocal Atherosclerosis. Kardiologiia. 2014;54(3):37-41. (In Russ.).
Hernesniemi JA, Vänni V, Hakala T. The prevalence of abdominal aortic aneurysm is consistently high among patients with coronary artery disease. Journal of Vascular Surgery. 2015;62(1):232-240. e3. https://doi.org/10.1016/j.jvs.2015.02.037
Vishwakarma P, Patwari P, Pradhan A, et al. Screening for prevalence of abdominal aortic aneurysm during transthoracic echocardiography in patient with significant coronary artery disease. Cardiology Research. 2021;12(5):318. https://doi.org/10.14740/cr1288
Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, von Allmen RS, Vrints CJM; ESC Committee for Practice Guidelines. ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). European Heart Journal. 2014;35(41):2873-2926. https://doi.org/10.1093/eurheartj/ehu281
Arakelyan VS, Jane AR, Gidaspov NA, Kulichkov PP, Bortnikova NV. Prevalence of cardiac risk factors in patients with abdominal aortic aneurysm. Aterotromboz. 2019;(1):138-147. (In Russ.). https://doi.org/10.21518/2307-1109-2019-1-138-147
Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, Dick F, van Herwaarden J, Karkos C, Koelemay M, Kölbel T, Loftus I, Mani K, Melissano G, Powell J, Szeberin Z, Esvs Guidelines Committee, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Kolh P, Lindholt JS, de Vega M, Vermassen F, Document Reviewers, Björck M, Cheng S, Dalman R, Davidovic L, Donas K, Earnshaw J, Eckstein H-H, Golledge J, Haulon S, Mastracci T, Naylor R, Ricco J-B, Verhagen H. Editor’s choice—European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. European Journal of Vascular and Endovascular Surgery. 2019;57(1):8-93. https://doi.org/10.1016/j.ejvs.2018.09.020
Elkalioubie A, Haulon S, Duhamel A, Rosa M, Rauch A, Staels B, Susen S, Van Belle E, Dupont A. Meta-analysis of abdominal aortic aneurysm in patients with coronary artery disease. American Journal of Cardiology. 2015;116(9):1451-1456. https://doi.org/10.1016/j.amjcard.2015.07.074
Mukai S, Yao H, Miyamoto T, Yamamura M, Nakagawa T, Ryomoto M. The long-term follow-up results of elective surgical treatment for abdominal aortic aneurysms. Annals of Thoracic and Cardiovascular Surgery. 2002;8(1):38-41.
2018 ESC/EACTS guidelines on myocardial revascularization. Russian Journal of Cardiology. 2019;(8):151-226. (In Russ.). https://doi.org/10.15829/1560-4071-2019-8-151-226
Writing Committee Members, Isselbacher EM, Preventza O, Black JH III, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo J. 2022 ACC/AHA Guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2022;80(24):e223-e393. https://doi.org/10.1161/cir.0000000000001106
Bath M, Gokani V, Sidloff D, Jones LR, Choke E, Sayers RD, Bown MJ. Systematic review of cardiovascular disease and cardiovascular death in patients with a small abdominal aortic aneurysm. Journal of British Surgery. 2015;102(8):866-872. https://doi.org/10.1002/bjs.9837
Karthikesalingam A, Bahia S, Patterson B, Peach G, Vidal-Diez A, Ray KK, Sharma R, Hinchliffe RJ, Holt PJ, Thompson MM. The shortfall in long-term survival of patients with repaired thoracic or abdominal aortic aneurysms: Retrospective case — control analysis of Hospital Episode Statistics. European Journal of Vascular and Endovascular Surgery. 2013;46(5):533-541. https://doi.org/10.1016/j.ejvs.2013.09.008
Hołda MK, Iwaszczuk P, Wszołek K, Chmiel J, Brzychczy A, Trystuła M, Misztal M. Coexistence and management of abdominal aortic aneurysm and coronary artery disease. Cardiology Journal. 2020;27(4):384-393. https://doi.org/10.5603/cj.a2018.0101
Hosokawa Y, Takano H, Aoki A, Inami T, Ogano M, Kobayashi N, Tanabe J, Yokoyama H, Kato T, Takagi H, Umemoto T, Takayama M, Mizuno K. Management of coronary artery disease in patients undergoing elective abdominal aortic aneurysm open repair. Clinical Cardiology: An International Indexed and Peer‐Reviewed Journal for Advances in the Treatment of Cardiovascular Disease. 2008;31(12):580-585. https://doi.org/10.1002/clc.20335
McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, Pierpont G, Santilli S, Rapp J, Hattler B, Shunk K, Jaenicke C, Thottapurathu L, Ellis N, Reda DJ, Henderson WG. Coronary-artery revascularization before elective major vascular surgery. New England Journal of Medicine. 2004;351(27):2795-2804. https://doi.org/10.1056/nejmoa041905
Sumin AN, Korok EV, Panfilov SD, Evdokimov DO, Raikh OI, Kislov EE, Ivanov SV, Barbarash LS. Preventive myocardial revascularisation before abdominal aortic interventions: long-term results. Russian Journal of Cardiology. 2013;(6):11-16. (In Russ.). https://doi.org/10.15829/1560-4071-2013-6-11-16
Sun T, Cheng Y-t, Zhang H-j, Chen S-h, Zhang D-h, Huang J, Zhang J-m, Li Z-z. Severe coronary artery disease in Chinese patients with abdominal aortic aneurysm: prevalence and impact on operative mortality. Chinese Medical Journal. 2012;125(6):1030-1034.
Spiridonov AA, Tutov EG, Arakelyan VS. Chirurgicheskoe lechenie anevrism bruschnoi aorty. M.: Isd-vo NC CCX im. A.N. Bakuleva RAMN. 2000;206. (In Russ.).
Williams AM, Watson J, Mansour MA, Sugiyama GT. Combined coronary artery bypass grafting and abdominal aortic aneurysm repair: presentation of 3 cases and a review of the literature. Annals of Vascular Surgery. 2016;30:321-330. https://doi.org/10.1016/j.avsg.2015.06.072
De La Motte L, Jensen L, Vogt K, Kehlet H, Schroeder T, Lonn L. Outcomes after elective aortic aneurysm repair: a nationwide Danish cohort study 2007—2010. European Journal of Vascular and Endovascular Surgery. 2013;46(1):57-64. https://doi.org/10.1016/j.ejvs.2013.04.020
Kim SM, Cho JY, Kim JH, Park K-H, Sim DS, Hong YJ, Ahn Y, Jeong MH. Successful endovascular aneurysm repair for abdominal aortic aneurysm in a patient with severe coronary artery disease undergoing off-pump coronary artery bypass grafting. Chonnam Medical Journal. 2014;50(1):31-36. https://doi.org/10.4068/cmj.2014.50.1.31
Field ML, Vallabhaneni SR, Kuduvalli M, Brennan JA, Torella F, McWilliams RG, Oo A. Combined cardiac surgery and endovascular repair of abdominal aortic aneurysms. Journal of Endovascular Therapy. 2013;20(3):345-349. https://doi.org/10.1583/12-3966r.1
Becquemin J-P, Pillet J-C, Lescalie F, Sapoval M, Goueffic Y, Lermusiaux P, Steinmetz E, Marzelle J; ACE trialists. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low-to moderate-risk patients. Journal of Vascular Surgery. 2011;53(5):1167-1173.e1. https://doi.org/10.1016/j.jvs.2010.10.124
Patel R, Sweeting MJ, Powell JT, Greenhalgh RM. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388(10058):2366-2374. https://doi.org/10.1016/S0140-6736(16)31135-7

Close metadata