老年心脏病学杂志（英文版）2006，Vol.3Issue(2)：73-76,4.
Prophylactic endovascular management of peripheral artery disease in elderly candidates prior to cardiac surgery
Prophylactic endovascular management of peripheral artery disease in elderly candidates prior to cardiac surgery
Gianluca Rigatelli 1Paolo Cardaioli 2Massimo Giordan 1Loris Roncon 1Emiliano Bedendo 1Tranquillo Milan 1Giorgio Rigatelli3
作者信息
- 1. Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Italy
- 2. Department of Cardiovascular Disease, Cittadella General Hospital, Padua, Italy
- 3. Department of Specialistic Medicine, Division of Cardiology, Legnago General Hospital Verona, Italy
- 折叠
摘要
Abstract
Background and objectives Peripheral vascular disease (PVD) is a major risk factor in candidates for cardiac surgery and can impact morbidity and mortality in the perioperative and follow-up period. Elderly patients with PVD may benefit from endovascular treatment prior to cardiac surgery. We sought to assess the common clinical settings requiring prophylactic endovascular treatment before coronary surgery in elderly patients, the results, and the mid-term impact on subsequent revascularization. Methods Between November 2002 and June 2006, 37 patients (25 males, mean age 79.9±8.3 years, mean serum creatinine 1.9±0.6 mg/dl) underwent endovascular repair of PVD before cardiac surgery. For each patient, diagnostic methods, indications for intervention, types of interventions, procedural success, and complications were recorded. Results Four clinical settings were identified: renal artery stenting prior to coronary surgery (7 patients), iliac artery angioplasty and stenting (10 patients) in order to facilitate aortic balloon pump insertion after surgery, subclavian artery angioplasty and stenting prior to utilization of ipsilateral arterial conduits bypass surgery (5patients), and carotid artery stenting before coronary surgery (15 patients). Technical success was achieved in all patients (100%);complications included brachial artery occlusion (1 patient), minor stroke (2 patients), contrast nephropathy (1 patient), and minor bleeding at the puncture site (3 patients). All patients underwent successful coronary or valvular surgery; no patients died in the perioperative period. After a mean follow-up of 26.6±3.1 months, all patients are alive and free from anginal symptoms or valvular dysfunction without clinical or Doppler ultrasonography evidence of restenosis of the implanted peripheral vascular stents. Conclusions It is not unusual for elderly patients who are candidates for cardiac surgery to require endovascular intervention for significant PVD prior to coronary bypass or valvular surgery. The results showed a low complication rate. The cardiologists have a fundamental role,not only in the diagnosis of peripheral vascular stenosis, which was seen frequently in patients with significant CAD, but also in the appropriate endovascular management of these high-risk patients.关键词
coronary disease/catheterization/angioplasty/peripheral vascular diseaseKey words
coronary disease/catheterization/angioplasty/peripheral vascular disease分类
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Gianluca Rigatelli,Paolo Cardaioli,Massimo Giordan,Loris Roncon,Emiliano Bedendo,Tranquillo Milan,Giorgio Rigatelli..Prophylactic endovascular management of peripheral artery disease in elderly candidates prior to cardiac surgery[J].老年心脏病学杂志（英文版）,2006,3(2):73-76,4.
