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Background and Design.- In accordance with the developments in invasive cardiology, more high risk and elderly patients are seen for coronary artery bypass grafting. These patients often have extensive atherosclerosis, involving more than one system that contributes to morbidity and mortality.
Material and Methods.- Between years 2001-2002, 130 patients who underwent coronary artery bypass grafting were retrospectively reviewed for presenting peripheral vascular disease which necessitates surgical revascularization. Sixteen patients were encountered to have co-existing critical carotid artery disease and/or lower limb ischemia.
Results.- In 10 patients the choice of treatment modality was synchronous procedures. Eight patients underwent carotid endarterectomy concomitant to the coronary bypass, one patient aortobifemoral bypass and one patient carotid endarterectomy and cross femoral bypass. Six patients underwent staged surgery. Although there was no mortality in synchronous approach group, one patient in the staged surgery group died. In concomitant approach group we used beating heart coronary revascularization for 8 patients. In all staged procedures CABG was done under cardiopulmonary bypass.
Conclusion.-The surgical management of patients with coronary artery disease and co-existing peripheral vascular disease has remained contraversial, however, this contraversy has gained momentum with the advent of off-pump coronary artery bypass grafting. According to our results, we highly recommend more liberal use of noninvasive vascular diagnostic tools for patients scheduled for coronary revascularization. We also believe that off-pump coronary artery surgery, as it avoids the harmful effects of cardiopulmonary bypass, may be the choice of surgical method for combined approach.