Simultaneous endovascular repair for abdominal aortic aneurysm and coronary artery bypass grafting in an octogenarian: A case report. (2020)

• Record Type: Journal Article
• Authors: Tien, Tran Quyet; Bang, Ho Tat; Cuong, Lam Thao; An, Nguyen Thai
• Is Part Of: International journal of surgery case reports. Volume 66(2020)
• Page Start: 72
• Page End: 75
• Publication Date: 2020
• Subjects: AAA abdominal aortic aneurysm -- CABG coronary artery bypass grafting -- CAD coronary artery disease -- CBP cardiopulmonary bypass -- CKMB creatine kinase-muscle/brain -- EVAR endovascular aneurysm repair -- GSV great saphenous vein -- LAD left anterior descending -- LCX left circumflex -- LIMA left internal mammary artery -- NSTEMI non-ST-segment elevation myocardial infarction -- RCA right coronary artery; Abdominal aortic aneurysms -- Coronary artery disease -- Endovascular aneurysm repair -- Coronary artery bypass grafting; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.11.036
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: AAA is frequently associated with CAD in elderly patients. The optimal management of CAD associated with AAA in an octogenarian is a challenge. Combined CABG and EVAR is a promising way to improve the therapeutic efficiency. Abstract: Introduction: Coronary artery disease (CAD) is commonly associated with abdominal aortic aneurysms (AAAs) in elderly patients. When severe CAD requiring coronary artery bypass grafting (CABG) is associated with an impending AAA in a high-risk patient, the options for the suitable timing of CABG and AAA repair strategy (one-stage or two-stage) are still being debated. Presentation of case: An 87-year-old man with non-ST-segment elevation myocardial infarction and a giant abdominal aortic aneurysm was transferred to our centre. Coronary angiography revealed triple-vessel coronary disease, and computed tomography confirmed a giant infrarenal fusiform abdominal aortic aneurysm 9 cm in maximal diameter. We simultaneously performed endovascular aneurysm repair prior to on-pump beating-heart coronary artery bypass grafting. The postoperative course was uneventful, and the patient was discharged on the 15th postoperative day. Conclusion: Combined endovascular aneurysm repair and on-pump beating heart coronary artery bypass grafting in a one-stage operation is a promising strategy to improve therapeutic efficiency in octogenarians. More studies are needed to compare the efficacy and safety of one-stage and two-stage operations to treat concomitant coronary artery disease and aortovascular pathology in the high-risk octogenarian patients.