Influence of Peripheral Vascular Occlusive Disease on the Morbidity and Mortality of Coronary Artery Bypass Grafting

Abstract

The impact of peripheral vascular occlusive disease (PVD) on outcome for patients who have undergone coronary artery bypass grafting (CABG) was assessed by comparing preoperative and intraoperative patient characteristics and outcome in 2 groups of patients who underwent CABG (patients with PVD, n=96; patients without PVD, n=593). Patients with PVD were significantly older (69+/-8.4 vs 63+/-8.7; p<0.0001), and had a higher incidence of diabetes mellitus (48% vs 32%; p<0.01), hypertension (62% vs 46%; p<0.01), preoperative cerebral infarction (26% vs 12%; p<0.001) and chronic renal dysfunction (11% vs 4.4%; p<0.01) than those without PVD. Postoperative morbidity and mortality were assessed, after those risk factors were adjusted, using multivariate logistic regression analysis. The perioperative myocardial infarction (PMI) rate and in-hospital mortality rate were significantly higher in patients with PVD than in patients without PVD (9.4% vs 3.0%; p=0.0108, 17% vs 2.7%; p=0.0003, respectively). The odds ratio of PMI and in-hospital mortality were 3.4 (95% confidence intervals (CI): 1.3-8.6) and 4.3 (95% CI: 2.0-9.5), respectively. Although the excess mortality rate was mainly the result of cardiac problems, such as low output syndrome or arrhythmia, in most of the cases, PVD, which may frequently prevent the use of the intraaortic balloon pump, also seemed to have a strong relation to postoperative morbidity and mortality.

Peripheral Arterial Disease

“…Table 2 shows increased relative risks for CBVD outcomes in those with versus without PAD. 35,37,39,40,43,48,49 ABI Ͻ0.9 was clearly and significantly associated with increased nonfatal (but not fatal) stroke in 1 study 43 ; in another analysis, severity of PAD was monotonically correlated with combined definite and possible stroke or transient ischemic attack. 35 A Spanish study found that PAD was associated with increased risk not only of ischemic stroke but also of hemorrhagic stroke (indeed, a somewhat higher risk ratio for hemorrhagic than ischemic stroke was observed).…”

Fracture of Popliteal Artery Stents

“…There is also a higher incidence of perioperative myocardial infarction and mortality in patients with peripheral vascular obstructive disease undergoing coronary artery bypass grafting than in those without such a risk factor. 10 However, for an active young patient with severely compromised popliteal artery blood flow, delaying the peripheral bypass surgery would not be a suitable management strategy.…”

Off-pump Coronary Artery Bypass Grafting in Elderly and High-risk Patients – A Review

“…In the Coronary Artery Surgery Study (CASS), PVD was found to be a greater significant predictor of mortality following surgery than a previous myocardial infarction or severity of angina (25% greater likelihood of mortality at any follow-up timepoint) [54]. Patients are more likely to have peri-and post-operative complications-MI (9.4% versus 3.0%, p = 0.0108) [55], arrhythmias (OR 1.7, p = 0.01), neurological complications (OR 1.7, p < 0.001), pulmonary complications (OR 1.4, p < 0.001), and intraoperative complications (OR 1.39, p = 0.02) [56]. A regional cohort study of 2871 patients undergoing CABG (patients with PVD, n = 755; patients without PVD, n = 2116) found that fiveyear mortality was significantly increased in patients with PVD (20% versus 8%, p < 0.001) whilst the adjusted hazard ratio of long term morality associated with PVD was 2.01 (95% CI: 1.57-2.58; p < 0.001) [57].…”