Our Strategy in a Patient with Large Abdominal Aortic Aneurysm and Symptomatic Coronary Artery Disease

Kazim Ergunes, Levent Yilik, Orhan Gokalp, Yuksel Besir, Ismail Yurekli, Erturk Karaagac, Yasar Gokkurt, Ali Gurbuz

Izmir Katip Celebi University Ataturk Training and Research Hospital, İZMİR, Turkey

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objective: In patients having symptomatic coronary artery disease and large abdominal aortic aneurysm is significant morbidity and mortality risk for surgical repair.

We presented a patient having symptomatic coronary artery disease and large abdominal aortic aneurysm.

Methods: A 55-year old man was hospitalised in our clinic on March 8, 2017. He had symptomatic coronary artery disease and large abdominal aortic aneurysm. The coronary angiography showed circumflex-obtuse magrin-1 , circumflex-obtuse magrin-2 , and left anterior descending coronary artery stenosis. The carotid artery angiography showed right and left carotid artery stenosis lesser than 50%. The computed tomography showed large abdominal aortic aneurysm (65 mm).

Results: Coronary artery bypass was performed first, followed by abdominal aortic aneurysm repair within 1 month. The saphenous vein grafts were anastomosed tocircumflex-obtuse magrin-1 , circumflex-obtuse magrin-2 coronary artery , and left internal thoracic artery was anastomosed left anterior descending coronary artery via a median sternotomy, with use of cardiopulmonary bypass, moderate systemic hypothermia (28^oC), and combined antegrade and retrograde ishothermic blood cardioplegia.Under general anesthesia, The abdomen was then opened, employing a midline incision from xyphoid to within several centimeters of the symphysis pubis.  Proximal end-to-end anastomosis was carried out to the cuff of aorta below the proximal clamp and distal end-to-side aorto-right common iliac artery bypass and aorto-left external iliac artery bypass was performed with 16/8 mm Dacron graft. The distal pulses of both lower extremity were palpable, postoperatively. The patient was discharged after six days with antiplatelet drugs.

Conclusions: Staged electiveabdominal aortic aneurysm repair may be performed safely and effectively after coronary artery bypass grafting.