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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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III. MANAGEMENT OF THE “POLYVASCULAR PATIENT”
2. ABDOMINAL AORTIC ANEURYSMS AND CONCOMITANT CORONARY DISEASE
B. Endovascular repair  THE MULTIFOCAL ATHEROSCLEROTIC PATIENT
DIAGNOSIS AND MANAGEMENT IN 2003


The Journal of Cardiovascular Surgery 2003 Giugno;44(3):453-7

lingua: Inglese

Indications for myocardial revascularization before endovascular aortic repair

Riambau V., Sionis A., Mulet J.

Institute of CardioVascular Diseases Hospital Clinic, University of Barcelona, Barcelona, Spain


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Due to ­the ­strong rela­tion­ship ­between ­abdominal aortic aneurysm (AAA) ­and cor­o­nary mor­did­ity ­and mor­tal­ity, it ­seems man­da­to­ry to ­spend ­some ­more ­time inves­ti­gat­ing ­about cor­o­nary ­risk of ­our endovascular aortic repair (EVAR) ­patients. Physical exam­ina­tion, ­basic labor­a­to­ry test­ing ­and ­ECG ­will ­allow us to deter­mine wheth­er ­the sur­gi­cal ­risk ­for a ­patient is ­low, mod­er­ate or ­high. In gen­er­al a ­patient ­who is at ­low ­risk ­will ­not ­need ­any fur­ther eval­u­a­tion. Those at ­who ­are at ­high ­risk usu­al­ly ­will under­go cor­o­nary angio­gra­phy. Patients ­who ­are at inter­me­di­ate ­risk, prob­ably ­the larg­est sub­group of ­patients can­di­date to ­EVAR, ­will ­often ­need addi­tion­al test­ing ­like assess­ment of rest­ing ­left ven­tric­u­lar func­tion, exer­cise ­stress test­ing, phar­mac­o­log­i­cal ­stress test­ing, ambu­la­to­ry ­ECG mon­i­tor­ing, ­and cor­o­nary angio­gra­phy as ­well as exer­cise ech­o­car­di­og­ra­phy or exer­cise myo­car­dial per­fu­sion imag­ing ­should be con­sid­ered. Patients under­go­ing an ­EVAR pro­ce­dure, ­who ­are ­found to ­have prog­nos­tic ­high-­risk cor­o­nary anat­o­my ­and in ­whom ­long-­term out­come ­would like­ly be ­improved by cor­o­nary revas­cu­lar­iza­tion, ­should gen­er­al­ly under­go revas­cu­lar­iza­tion ­first. In con­clu­sion, we rec­om­mend to eval­u­ate ­the car­diac stat­us of EVAR’s ­patients in ­order to ­reduce ­the ­most com­mon seri­ous mor­bid­ity relat­ed to ­this ­new ther­a­peu­tic modal­ity.

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