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Annals of Surgery logoLink to Annals of Surgery
. 1984 Feb;199(2):223–233. doi: 10.1097/00000658-198402000-00016

Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management.

N R Hertzer, E G Beven, J R Young, P J O'Hara, W F Ruschhaupt 3rd, R A Graor, V G Dewolfe, L C Maljovec
PMCID: PMC1353337  PMID: 6696538

Abstract

In an attempt to reduce early and late mortality caused by myocardial infarction, coronary angiography was performed in 1000 patients (mean age, 64 years) under consideration for elective peripheral vascular reconstruction since 1978. Those found to have severe, surgically correctable coronary artery disease (CAD) were advised to undergo myocardial revascularization (CABG), usually preceding other vascular procedures. The primary vascular diagnosis was abdominal aortic aneurysm (AAA) in 263 patients (mean age, 67 years), cerebrovascular disease (CVD) in 295 (mean age, 64 years), and lower extremity ischemia (ASO) in 381 (mean age, 61 years). Severe correctable CAD was identified in 25% of the entire series (AAA, 31%; CVD, 26%; and ASO, 21%). Surgical CAD was documented in 34% of patients suspected to have CAD by clinical criteria (AAA, 44%; CVD, 33%; and ASO, 30%) and in 14% of those without previous indications of CAD (AAA, 18%; CVD, 17%; and ASO, 8%). Cardiac procedures (216 CABG) were performed in 226 patients (AAA, 30%; CVD, 22%; and ASO, 19%), with 12 (5.3%) postoperative deaths. A total of 796 patients underwent 1066 peripheral vascular operations with an early mortality of 2.0% (AAA, 3.4%; ASO, 1.9%; and CVD, 0.3%), but only one death (0.8%) occurred in the group of 130 patients having preliminary CABG. The overall operative mortality for 1292 cardiac and peripheral vascular procedures was 2.6%.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brown O. W., Hollier L. H., Pairolero P. C., Kazmier F. J., McCready R. A. Abdominal aortic aneurysm and coronary artery disease. Arch Surg. 1981 Nov;116(11):1484–1488. doi: 10.1001/archsurg.1981.01380230098015. [DOI] [PubMed] [Google Scholar]
  2. Burnham S. J., Johnson G., Jr, Gurri J. A. Mortality risks for survivors of vascular reconstructive procedures. Surgery. 1982 Dec;92(6):1072–1076. [PubMed] [Google Scholar]
  3. CUTLER S. J., EDERER F. Maximum utilization of the life table method in analyzing survival. J Chronic Dis. 1958 Dec;8(6):699–712. doi: 10.1016/0021-9681(58)90126-7. [DOI] [PubMed] [Google Scholar]
  4. Cooperman M., Pflug B., Martin E. W., Jr, Evans W. E. Cardiovascular risk factors in patients with peripheral vascular disease. Surgery. 1978 Oct;84(4):505–509. [PubMed] [Google Scholar]
  5. Crawford E. S., Bomberger R. A., Glaeser D. H., Saleh S. A., Russell W. L. Aortoiliac occlusive disease: factors influencing survival and function following reconstructive operation over a twenty-five-year period. Surgery. 1981 Dec;90(6):1055–1067. [PubMed] [Google Scholar]
  6. Crawford E. S., Morris G. C., Jr, Howell J. F., Flynn W. F., Moorhead D. T. Operative risk in patients with previous coronary artery bypass. Ann Thorac Surg. 1978 Sep;26(3):215–221. doi: 10.1016/s0003-4975(10)63673-9. [DOI] [PubMed] [Google Scholar]
  7. Crawford E. S., Saleh S. A., Babb J. W., 3rd, Glaeser D. H., Vaccaro P. S., Silvers A. Infrarenal abdominal aortic aneurysm: factors influencing survival after operation performed over a 25-year period. Ann Surg. 1981 Jun;193(6):699–709. doi: 10.1097/00000658-198106000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. DEBAKEY M. E., CRAWFORD E. S., COOLEY D. A., MORRIS G. C., Jr, GARRET H. E., FIELDS W. S. CEREBRAL ARTERIAL INSUFFICIENCY: ONE TO 11-YEAR RESULTS FOLLOWING ARTERIAL RECONSTRUCTIVE OPERATION. Ann Surg. 1965 Jun;161:921–945. doi: 10.1097/00000658-196506000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Diehl J. T., Cali R. F., Hertzer N. R., Beven E. G. Complications of abdominal aortic reconstruction. An analysis of perioperative risk factors in 557 patients. Ann Surg. 1983 Jan;197(1):49–56. [PMC free article] [PubMed] [Google Scholar]
  10. Ennix C. L., Jr, Lawrie G. M., Morris G. C., Jr, Crawford E. S., Howell J. F., Reardon M. J., Weatherford S. C. Improved results of carotid endarterectomy in patients with symptomatic coronary disease: an analysis of 1,546 consecutive carotid operations. Stroke. 1979 Mar-Apr;10(2):122–125. doi: 10.1161/01.str.10.2.122. [DOI] [PubMed] [Google Scholar]
  11. Goldman L., Caldera D. L., Nussbaum S. R., Southwick F. S., Krogstad D., Murray B., Burke D. S., O'Malley T. A., Goroll A. H., Caplan C. H. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977 Oct 20;297(16):845–850. doi: 10.1056/NEJM197710202971601. [DOI] [PubMed] [Google Scholar]
  12. Hertzer N. R. Fatal myocardial infarction following abdominal aortic aneurysm resection. Three hundred forty-three patients followed 6--11 years postoperatively. Ann Surg. 1980 Nov;192(5):667–673. doi: 10.1097/00000658-198019250-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hertzer N. R. Fatal myocardial infarction following lower extremity revascularization. Two hundred seventy-three patients followed six to eleven postoperative years. Ann Surg. 1981 Apr;193(4):492–498. [PMC free article] [PubMed] [Google Scholar]
  14. Hertzer N. R., Lees C. D. Fatal myocardial infarction following carotid endarterectomy: three hundred thirty-five patients followed 6-11 years after operation. Ann Surg. 1981 Aug;194(2):212–218. doi: 10.1097/00000658-198108000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hertzer N. R., Loop F. D., Taylor P. C., Beven E. G. Combined myocardial revascularization and carotid endarterectomy. Operative and late results in 331 patients. J Thorac Cardiovasc Surg. 1983 Apr;85(4):577–589. [PubMed] [Google Scholar]
  16. Hertzer N. R. Myocardial ischemia. Surgery. 1983 Jan;93(1 Pt 1):97–101. [PubMed] [Google Scholar]
  17. Hertzer N. R., Young J. R., Kramer J. R., Phillips D. F., deWolfe V. G., Ruschhaupt W. F., 3rd, Beven E. G. Routine coronary angiography prior to elective aortic reconstruction: results of selective myocardial revascularization in patients with peripheral vascular disease. Arch Surg. 1979 Nov;114(11):1336–1344. doi: 10.1001/archsurg.1979.01370350138018. [DOI] [PubMed] [Google Scholar]
  18. Hibler B. A., Wright J. O., Wright C. B., Ehrenhaft J. L., Doty D. B., Rossi N. P. Coronary artery bypass surgery in the elderly. Arch Surg. 1983 Apr;118(4):402–404. doi: 10.1001/archsurg.1983.01390040014003. [DOI] [PubMed] [Google Scholar]
  19. Kannel W. B., McGee D. L. Diabetes and cardiovascular disease. The Framingham study. JAMA. 1979 May 11;241(19):2035–2038. doi: 10.1001/jama.241.19.2035. [DOI] [PubMed] [Google Scholar]
  20. Loop F. D., Cosgrove D. M., Lytle B. W., Golding L. R. Life expectancy after coronary artery surgery. Am J Surg. 1981 Jun;141(6):665–671. doi: 10.1016/0002-9610(81)90074-x. [DOI] [PubMed] [Google Scholar]
  21. Loop F. D., Cosgrove D. M., Lytle B. W., Thurer R. L., Simpfendorfer C., Taylor P. C., Proudfit W. L. An 11 year evolution of coronary arterial surgery (1968-1978). Ann Surg. 1979 Oct;190(4):444–455. doi: 10.1097/00000658-197910000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. McCollum C. H., Garcia-Rinaldi R., Graham J. M., DeBakey M. E. Myocardial revascularization prior to subsequent major surgery in patients with coronary artery disease. Surgery. 1977 Mar;81(3):302–304. [PubMed] [Google Scholar]
  23. von Knorring J. Postoperative myocardial infarction: a prospective study in a risk group of surgical patients. Surgery. 1981 Jul;90(1):55–60. [PubMed] [Google Scholar]

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