Combined Myocardial and Peripheral Revascularization of the Lower Limbs

Abstract

In a series of 2,786 patients submitted to operation for peripheral arterial disease of the lower limbs from 1964 to 1986, the overall mortality rate was 6.9%, and 69% of these died of acute myocardial infarction (AMI). In order to reduce the incidence of AMI, from 1979 to 1990, 258 patients with lower limb ischemia were investigated for coronary artery disease (CAD). All of them had clinical signs of myocardial ischemia and were submitted to coronary arteriography after previous evaluation with dipyridamole thallium scanning and echocardiography. Severe CAD was shown in 137 patients, and combined myocardial and peripheral revascularization was planned: coronary artery bypass grafting (CABG) was performed first on 61 patients followed by peripheral operation after an average of three weeks; simultaneous procedure was performed on 76 patients upon intraoperative decision. The overall mortality rate was 3.6%: 3.3% for staged and 3.9% for simultaneous procedure. No myocardial infarction was registered in the early postoperative period, but peripheral graft occlusion in 5.8% (8/137) was the main complication. The actuarial fiveyear survival rate was 87%; the actuarial five-year patency of the peripheral grafts was 61.9%.The authors conclude that combined myocardial and peripheral revascularization prevents early death from myocardial infarction and improves late survival without increasing surgical risks; with proper judgment simultaneous operations can be performed.