Abstract
Backgrounds
Endovascular management of peripheral vascular disease before cardiac surgery is still debated. We sought to present our preliminary experience of endovascular stent placement in patients scheduled for urgent cardiac surgery.
Methods
Between November 2003 and August 2005, 20 patients scheduled for urgent coronary surgery (13 males, mean age 72.5±5.3 years) underwent endovascular repair of PVD on the basis of clinical and angiographic indications. Aspirin (100 mg/day) plus low molecular weight heparin (nadroparin calcium) 100 IU/kg/12 h for urgent coronary surgical revascularization was administered after the procedure.
Results
Endovascular stenting has been performed in four clinical settings: renal artery stenting prior to coronary surgery (nine patients) to decrease the impact of extracorporeal circulation on an impaired renal function, iliac artery artery angioplasty and stenting (eight patients) in order to facilitate aortic balloon pump insertion after surgery, subclavian artery angioplasty and stenting propedeutical to arterial conduits bypass surgery (one patient), carotid artery stenting before coronary surgery (two patients). All patients underwent successful endovascular repair followed by cardiac surgery. At a mean follow-up of 12±4.6 months all patients are alive and without evident thrombosis or restenosis of the implanted vascular stents.
Conclusions
Endovascular treatment of PVD in patients scheduled for urgent coronary surgery may be effective, relatively safe and lasting in spite of low dose antiplatelet regimen.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Nallamothu BK, Chetcuti S, Mukherjee D, et al. (2003) Long-term prognostic implication of extracardiac vascular disease in patients undergoing percutaneous coronary intervention. Am J Cardiol 92:964–966
Leavitt BJ, Sheppard L, Maloney C, et al. (2004) Northern New England Cardiovascular Disease Study Group. Effect of diabetes and associated conditions on long-term survival after coronary artery bypass graft surgery. Circulation 110(11 Suppl 1):II41–II44
Dorffler-Melly J, Koopman M, Prins M, Buller H (2005) Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment. Cochrane Database Syst Rev (1):CD002071
Girolami B, Bernardi E, Prins MH, et al. (2000) Antiplatelet therapy and other interventions after revascularisation procedures in patients with peripheral arterial disease: a meta-analysis. Eur J Vasc Endovasc Surg 19:370–380
Murphy TP, Rundback JH, Cooper C, Kiernan MS (2002) Chronic renal ischemia: implications for cardiovascular disease risk. J Vasc Interv Radiol 13:1187–1198
Szczech LA, Best PJ, Crowley E, et al. (2002) Bypass Angioplasty Revascularization Investigation (BARI) Investigators.Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation. Circulation 105:2253–2258
Vashist A, Heller EN, Brown EJ Jr, Alhaddad IA (2002) Renal artery stenosis: a cardiovascular perspective. Am Heart J 143:559–564
Martin-Ucar AE, Patel RL (2002) Preventive stent placement for renal artery stenosis prior to emergent coronary artery bypass grafting. J Endovasc Ther 9:218–220
Kafetzakis A, Giannoukas AD, Kochiadakis G (2001) Occult aorto-iliac disease in patients with symptomatic coronary artery disease. Int Angiol 20:295–300
Zeldis SM, Wilkens JM, Goodman M, et al (1983) Unsuspected vascular disease: a potential limitation to the use of the intra-aortic balloon. Cathet Cardiovasc Diagn 9:137–141
Rigatelli G, Rigatelli G (2005) Screening angiography of supraaortic vessels performed by invasive cardiologists at the time of cardiac catheterization: indications and results. Int J Cardiovasc Imaging 21:179–183
Bicknell CD, Subramanian A, Wolfe JH (2004) Coronary subclavian steal syndrome. Eur J Vasc Endovasc Surg 27:220–221
Ochi M, Hatori N, Hinokiyama K, Saji Y, Tanaka S (2003) Subclavian artery reconstruction in patients undergoing coronary artery bypass grafting. Ann Thorac Cardiovasc Surg 9:57–61
Westerband A, Rodriguez JA, Ramaiah VG, Diethrich EB (2003) Endovascular therapy in prevention and management of coronary-subclavian steal. J Vasc Surg 38:699–703
Mackey WC. Carotid and coronary disease: staged or simultaneous management? Semin Vasc Surg 1998 Mar; 11(1): 36–40
Waigand J, Gross C (2001) Carotid artery stent placement prior to coronary angioplasty or coronary bypass graft surgery. Curr Interv Cardiol Rep 3:117–129
Bandyk DF, Back MR, Johnson BL (2003) Carotid intervention prior to or during coronary artery bypass grafting. When is it necessary? J Cardiovasc Surg (Torino). 44:401–405
Babatasi G, Massetti M, Theron J, Khayat A (1997) Asymtomatic carotid stenosis in patients undergoing major cardiac surgery: can percutaneous carotid angioplasty be an alternative? Eur J Cardiothorac Surg 11: 547–553
Englberger L, Faeh B, Berdat PA, Eberli F, Meier B, Carrel T (2004) Impact of clopidogrel in coronary artery bypass grafting. Eur J Cardiothorac Surg 26:96–101
Tran H, Anand SS (2004) Oral antiplatelet therapy in cerebrovascular disease, coronary artery disease, and peripheral arterial disease. JAMA 292:1867–174
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rigatelli, G., Cardaioli, P., Giordan, M. et al. Peripheral vascular disease endovascular management in patients scheduled for cardiac surgery: a clinical-angiographic approach. Int J Cardiovasc Imaging 22, 305–310 (2006). https://doi.org/10.1007/s10554-005-9065-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-005-9065-4