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Frequency of Coronary Artery Disease in Patients Undergoing Peripheral Artery Disease Surgery

      The prevalence of coronary artery disease (CAD) in patients with peripheral arterial disease (PAD) varies widely in published reports. This is likely due at least in part to significant differences in how PAD and CAD were both defined and diagnosed. In this report, the investigators describe 78 patients with PAD who underwent preoperative coronary angiography before elective peripheral revascularization and provide a review of published case series. Among the patients included, the number with concomitant CAD varied from 55% in those with lower-extremity stenoses to as high as 80% in those with carotid artery disease. The number of coronary arteries narrowed by ≥50% was 1 in 28%, 2 in 24%, and 3 in 19%; 28% did not have any angiographic evidence of CAD. The review of published research resulted in the identification of 19 case series in which a total of 3,969 patients underwent preoperative coronary angiography before elective PAD surgery; in the 2,687 who were described according to the location of the PAD, 55% had ≥1 epicardial coronary artery with ≥70% diameter narrowing. The highest prevalence of concomitant CAD was in patients with severe carotid artery disease (64%). In conclusion, despite sharing similar risk factors, the prevalence of obstructive CAD in patients with PAD ranges widely and appears to differ across PAD locations. Thus, the decision to perform coronary angiography should be based on indications independent of the planned PAD surgery.
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      References

        • Juergens J.L.
        • Barker N.W.
        • Hines Jr, E.A.
        Arteriosclerosis obliterans: review of 520 cases with special reference to pathogenic and prognostic factors.
        Circulation. 1960; 21: 188-195
        • Hertzer N.R.
        Basic data concerning associated coronary disease in peripheral vascular patients.
        Ann Vasc Surg. 1987; 1: 616-620
        • Eagle K.A.
        • Berger P.B.
        • Calkins H.
        • Chaitman B.R.
        • Ewy G.A.
        • Fleischmann K.E.
        • Fleisher L.A.
        • Froehlich J.B.
        • Gusberg R.J.
        • Leppo J.A.
        • Ryan T.
        • Schlant R.C.
        • Winters Jr, W.L.
        • Gibbons R.J.
        • Antman E.M.
        • Alpert J.S.
        • Faxon D.P.
        • Fuster V.
        • Gregoratos G.
        • Jacobs A.K.
        • Hiratzka L.F.
        • Russell R.O.
        • Smith Jr, S.C.
        ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery).
        J Am Coll Cardiol. 2002; 39: 542-553
        • Bayazit M.
        • Gol M.K.
        • Battaloglu B.
        • Tokmakoglu H.
        • Tasdemir O.
        • Bayazit K.
        Routine coronary arteriography before abdominal aortic aneurysm repair.
        Am J Surg. 1995; 170: 246-250
        • Shimada T.
        • Toyoda K.
        • Inoue T.
        • Kamouchi M.
        • Matsumoto T.
        • Hiyamuta K.
        • Imaizumi T.
        • Okada Y.
        Prediction of coronary artery disease in patients undergoing carotid endarterectomy.
        J Neurosurg. 2005; 103: 593-596
        • Gajraj H.
        • Jamieson C.W.
        Coronary artery disease in patients with peripheral vascular disease.
        Br J Surg. 1994; 81: 333-342
        • Acinapura A.J.
        • Rose D.M.
        • Kramer M.D.
        • Jacobowitz I.J.
        • Cunningham Jr, J.N.
        Role of coronary angiography and coronary artery bypass surgery prior to abdominal aortic aneurysmectomy.
        J Cardiovasc Surg (Torino). 1987; 28: 552-557
        • Aoshima S.
        • Bang H.R.
        • Masuda N.
        • Tawarahara K.
        • Taguchi T.
        • Terada H.
        • Kaneko M.
        • Kurata C.
        • Kobayashi A.
        • Yamazaki N.
        • et al.
        Coronary artery disease in patients with arteriosclerosis obliterans of the lower extremities or aortic aneurysm.
        Intern Med. 1992; 31: 994-997
        • Blombery P.A.
        • Ferguson I.A.
        • Rosengarten D.S.
        • Stuchbery K.E.
        • Miles C.R.
        • Black A.J.
        • Pitt A.
        • Anderson S.T.
        • Harper R.W.
        • Federman J.
        The role of coronary artery disease in complications of abdominal aortic aneurysm surgery.
        Surgery. 1987; 101: 150-155
        • Deville C.
        • Kerdi S.
        • Madonna F.
        • de la Renaudiere D.F.
        • Labrousse L.
        Infrarenal abdominal aortic aneurysm repair: detection and treatment of associated carotid and coronary lesions.
        Ann Vasc Surg. 1997; 11: 467-472
        • Garcia S.
        • Moritz T.E.
        • Ward H.B.
        • Pierpont G.
        • Goldman S.
        • Larsen G.C.
        • Littooy F.
        • Krupski W.
        • Thottapurathu L.
        • Reda D.J.
        • McFalls E.O.
        Usefulness of revascularization of patients with multivessel coronary artery disease before elective vascular surgery for abdominal aortic and peripheral occlusive disease.
        Am J Cardiol. 2008; 102: 809-813
        • Her K.
        • Choi C.
        • Park Y.
        • Shin H.
        • Won Y.
        Concomitant peripheral artery disease and asymptomatic coronary artery disease: a management strategy.
        Ann Vasc Surg. 2008; 22: 649-656
        • Hertzer N.R.
        • Beven E.G.
        • Young J.R.
        • O'Hara P.J.
        • Ruschhaupt III, W.F.
        • Graor R.A.
        • Dewolfe V.G.
        • Maljovec L.C.
        Coronary artery disease in peripheral vascular patients.
        Ann Surg. 1984; 199: 223-233
        • Hofmann R.
        • Kypta A.
        • Steinwender C.
        • Kerschner K.
        • Grund M.
        • Leisch F.
        Coronary angiography in patients undergoing carotid artery stenting shows a high incidence of significant coronary artery disease.
        Heart. 2005; 91: 1438-1441
        • Hosokawa Y.
        • Takano H.
        • Aoki A.
        • Inami T.
        • Ogano M.
        • Kobayashi N.
        • Tanabe J.
        • Yokoyama H.
        • Kato T.
        • Takagi H.
        • Umemoto T.
        • Takayama M.
        • Mizuno K.
        Management of coronary artery disease in patients undergoing elective abdominal aortic aneurysm open repair.
        Clin Cardiol. 2008; 31: 580-585
        • Kieffer E.
        • Chiche L.
        • Baron J.F.
        • Godet G.
        • Koskas F.
        • Bahnini A.
        Coronary and carotid artery disease in patients with degenerative aneurysm of the descending thoracic or thoracoabdominal aorta: prevalence and impact on operative mortality.
        Ann Vasc Surg. 2002; 16: 679-684
        • Kioka Y.
        • Tanabe A.
        • Kotani Y.
        • Yamada N.
        • Nakahama M.
        • Ueda T.
        • Seitou T.
        • Maruyama M.
        Review of coronary artery disease in patients with infrarenal abdominal aortic aneurysm.
        Circ J. 2002; 66: 1110-1112
        • Kishi K.
        • Ito S.
        • Hiasa Y.
        Risk factors and incidence of coronary artery lesions in patients with abdominal aortic aneurysms.
        Intern Med. 1997; 36: 384-388
        • Monaco M.
        • Stassano P.
        • Di Tommaso L.
        • Pepino P.
        • Giordano A.
        • Pinna G.B.
        • Iannelli G.
        • Ambrosio G.
        Systematic strategy of prophylactic coronary angiography improves long-term outcome after major vascular surgery in medium- to high-risk patients: a prospective, randomized study.
        J Am Coll Cardiol. 2009; 54: 989-996
        • Sasaki Y.
        • Isobe F.
        • Kinugasa S.
        • Iwata K.
        • Murakami T.
        • Saito M.
        • Motoki M.
        Influence of coronary artery disease on operative mortality and long-term survival after abdominal aortic aneurysm repair.
        Surg Today. 2004; 34: 313-317
        • Takahashi J.
        • Okude J.
        • Gohda T.
        • Murakami T.
        • Hatakeyama M.
        • Sasaki S.
        • Yasuda K.
        Coronary artery bypass surgery in patients with abdominal aortic aneurysm: detection and treatment of concomitant coronary artery disease.
        Ann Thorac Cardiovasc Surg. 2002; 8: 213-219
        • Tomatis L.A.
        • Fierens E.E.
        • Verbrugge G.P.
        Evaluation of surgical risk in peripheral vascular disease by coronary arteriography: a series of 100 cases.
        Surgery. 1972; 71: 429-435
        • Utoh J.
        • Goto H.
        • Hirata T.
        • Hara M.
        • Kitamura N.
        Routine coronary angiography prior to abdominal aortic aneurysm repair: incidence of silent coronary artery disease.
        Panminerva Med. 1998; 40: 107-109
        • Fowkes F.G.
        • Low L.P.
        • Tuta S.
        • Kozak J.
        Ankle-brachial index and extent of atherothrombosis in 8891 patients with or at risk of vascular disease: results of the international AGATHA study.
        Eur Heart J. 2006; 27: 1861-1867
        • Mautner G.C.
        • Berezowski K.
        • Mautner S.L.
        • Roberts W.C.
        Degrees of coronary arterial narrowing at necropsy in men with large fusiform abdominal aortic aneurysm.
        Am J Cardiol. 1992; 70: 1143-1146
        • Mautner G.C.
        • Mautner S.L.
        • Roberts W.C.
        Amounts of coronary arterial narrowing by atherosclerotic plaque at necropsy in patients with lower extremity amputation.
        Am J Cardiol. 1992; 70: 1147-1151
        • McFalls E.O.
        • Ward H.B.
        • Moritz T.E.
        • Goldman S.
        • Krupski W.C.
        • Littooy F.
        • Pierpont G.
        • Santilli S.
        • Rapp J.
        • Hattler B.
        • Shunk K.
        • Jaenicke C.
        • Thottapurathu L.
        • Ellis N.
        • Reda D.J.
        • Henderson W.G.
        Coronary-artery revascularization before elective major vascular surgery.
        N Engl J Med. 2004; 351: 2795-2804
        • Poldermans D.
        • Schouten O.
        • Vidakovic R.
        • Bax J.J.
        • Thomson I.R.
        • Hoeks S.E.
        • Feringa H.H.
        • Dunkelgrun M.
        • de Jaegere P.
        • Maat A.
        • van Sambeek M.R.
        • Kertai M.D.
        • Boersma E.
        A clinical randomized trial to evaluate the safety of a noninvasive approach in high-risk patients undergoing major vascular surgery: the DECREASE-V Pilot Study.
        J Am Coll Cardiol. 2007; 49: 1763-1769
        • Mason J.J.
        • Owens D.K.
        • Harris R.A.
        • Cooke J.P.
        • Hlatky M.A.
        The role of coronary angiography and coronary revascularization before noncardiac vascular surgery.
        JAMA. 1995; 273: 1919-1925
        • Gersh B.J.
        • Rihal C.S.
        • Rooke T.W.
        • Ballard D.J.
        Evaluation and management of patients with both peripheral vascular and coronary artery disease.
        J Am Coll Cardiol. 1991; 18: 203-214