Open surgical repair of abdominal aortic aneurysms and dissecting aneurysms in patients with coronary artery disease: a single-center experience
DOI:
https://doi.org/10.14739/2310-1210.2025.5.334168Keywords:
abdominal aortic aneurysm, dissecting aneurysm, coronary artery disease, coronary artery bypass grafting, coronary stenting, surgical repair, myocardial revascularization, comorbidities, surgical treatment, in-hospital mortalityAbstract
Aim. To summarize the experience of pre- and postoperative management of patients with abdominal aortic aneurysms or dissections associated with coronary artery disease (CAD), and to evaluate the effectiveness of open surgical repair combined with myocardial revascularization based on a single specialized center’s clinical experience.
Materials and methods. The study included 75 patients (100.0 %) with infrarenal abdominal aortic aneurysms. Patients were initially divided into subgroup A (non-dissecting aneurysm) and subgroup B (dissecting aneurysm). All patients were then further stratified into three groups: Group 1 (comparison group) included patients without a diagnosed CAD; Group 2 consisted of patients with CAD who had previously undergone stenting or coronary artery bypass grafting (CABG) / off-pump coronary artery bypass (OPCAB); and Group 3 comprised patients with CAD who, during the same hospitalization, underwent surgical correction of both CAD and abdominal aortic aneurysm.
Results. Most patients who underwent myocardial revascularization (Groups 2 and 3) had multivessel coronary artery disease (MVCAD), confirmed by coronary ventriculography (CVG). Triple-vessel disease was observed in 78.9 % of patients, double-vessel disease in 15.8 %, and significant left main coronary artery stenosis (≥70 %) in 5.3 %. Patients who underwent CABG / OPCAB had an average ICU stay of 59.89 ± 20.20 hours, with a mean mechanical ventilation (MV) duration of 5.00 ± 2.40 hours. In the same group, after abdominal aortic aneurysm correction, the average ICU stay was 78.92 ± 53.93 hours, and the mean MV duration was 7.58 ± 6.71 hours. The overall complication rate was the highest in Group 1 (37.84 %), where the most extensive reconstructive procedures were performed. The highest postoperative in-hospital mortality was also observed in Group 1 in 4 (10.81 %) cases.
Conclusions. Myocardial revascularization should take priority over aortic reconstruction. This approach minimizes the risk of ischemic complications and allows for a safe transition to the next stage of treatment. A comparative analysis of the three clinical groups showed the worst outcomes in patients without prior revascularization, statistically confirming the effectiveness of a comprehensive treatment strategy (p < 0.05).
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