Fatal myocardial infarction following peripheral vascular operations

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Coronary artery disease (CAD) is the most common cause of early postoperative mortality and late death among patients who require surgical management of peripheral vascular disease. Several large series1–10 have indicated that myocardial infarction is responsible for 40% to 70% of all eventual deaths among patients who undergo abdominal aortic aneurysm resection, aortoiliofemoral or femoropopliteal arterial reconstruction, or carotid endarterectomy, and that fatal myocardial infarction occurs with predictably greater frequency among patients who have preoperative evidence of CAD. In such patients, cardiac complications exceed those associated with the underlying peripheral vascular disease that initially required investigation. Szilagyi et al7 found that 71% of patients with untreated abdominal aortic aneurysms died during observation from either myocardial infarction or aneurysm rupture. Previous reports from the Cleveland Clinic6 and others4, 8 have demonstrated that 5- and 10-year mortality rates surpass the incidence of graft occlusion following either aorto-femoral or femoropopliteal bypass. DeWeese et al5 and Thompson et al9 have shown that myocardial infarction accounts for three to five times the number of late deaths caused by stroke among patients who require carotid endarterectomy.

Several studies suggest that patients who have had previous direct myocardial revascularization sustain fewer cardiac complications after subsequent vascular and other major operations than would be anticipated even in the absence of known CAD.11, 12 Since cardiac complications appear to be particularly prevalent among patients who have peripheral vascular disease, routine coronary angiography has been recommended to all patients scheduled for elective peripheral vascular operations at the Cleveland Clinic . . .



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