Chonnam Med J.  2014 Apr;50(1):31-36. 10.4068/cmj.2014.50.1.31.

Successful Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm in a Patient with Severe Coronary Artery Disease Undergoing Off-Pump Coronary Artery Bypass Grafting

• Kim SM
• Cho JY
• Kim JH
• Park KH
• Sim DS
• Hong YJ
• Ahn Y
• Jeong MH

• KMID: 1889761
• DOI: http://doi.org/10.4068/cmj.2014.50.1.31

Abstract

It is well known that patients with abdominal aortic aneurysm (AAA) often have concomitant coronary artery disease (CAD). In cases of AAA with severe CAD requiring coronary artery bypass grafting (CABG), two therapeutic strategies regarding the timing of CABG can be considered: staged or simultaneous operations. However, the ideal treatment of patients with large AAA and critical CAD remains controversial. We experienced a case of successful endovascular aneurysm repair after off-pump CABG in a 70-year-old patient who had a huge AAA and critical CAD.

Keyword

Aortic aneurysm, Abdominal; Aneurysm; Coronary artery disease

MeSH Terms

Aged
Aneurysm*
Aortic Aneurysm, Abdominal*
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump*
Coronary Artery Disease*
Humans
Transplants*

Figure

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  FIG. 1 Electrocardiography showed sinus rhythm with first-degree atrioventricular block, left atrial enlargement, and left bundle branch block.

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  FIG. 2 Two-dimensional echocardiographic findings. Marked dilation of the LV chamber with severe LV systolic dysfunction (A) and a huge apical thrombus (B). Severe MR with PISA radius of 0.99 cm (C) and EROA of 0.5 cm2 (D). LV: left ventricle, MR: mitral regurgitation, PISA: proximal isovelocity surface area, EROA: effective regurgitant orifice area.

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  FIG. 3 Ultrasonographic and CT findings of AAA. A 76-mm abdominal aortic aneurysm with thrombosed false lumen shown by abdominal ultrasonography (A). Aneurysmal dilatation of the infra-renal abdominal aorta (B) and both thrombosed common iliac arteries (C) shown by CT angiography. Three-dimensional reconstructed image demonstrating aneurysmal dilatation infra-renal abdominal aorta extending to both the common and internal iliac arteries (D). AAA: abdominal aortic aneurysm, CT: computed tomography.

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  FIG. 4 Tc-99m MIBI myocardial SPECT showing fixed perfusion defect in the apex, anterior wall, and inferior wall. Tc-99m MIBI: technetium-99m methoxyisobutylisonitrile, SPECT: single-proton emission computed tomography.

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  FIG. 5 Aortographic and coronary angiographic findings. Huge infra-renal abdominal aneurysm shown by aortogram (A). Near total occlusion in mLAD and critical stenosis in LCx-os (B) with collateral flow to RCA (C) and total occlusion in dRCA, visualized only by nonselective ascending aortogram due to its anomalous origin (D). mLAD: middle left anterior descending artery, LCx-os: ostium of the left circumflex artery, dRCA: distal right coronary artery.

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  FIG. 6 Endovascular aneurysm repair (EVAR) findings. Implantation of a main body graft stent (A) and deployment of stent for the right common iliac artery (B). Stent expansion to its distal end using a balloon (C). Good expansion of the stents without any leakage (D).

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