Kamal Saleem, Syed Afzal Ahmed, Eitezaz Ahmed, Muhammad Zameer, Feroze Shah.
Abdominal Aortic Aneurysm and coexisting Coronary Artery Disease: A Case Report and review of literature.
J Coll Physicians Surg Pak Jan ;9(2):109-11.

Patients presenting with severe and/or unstable coronary artery disease along with an acutely enlarging or very big abdominal aortic aneurysm are best managed by simultaneous myocardial revascularization and abdominal aortic repair procedures. An experience of a patient who had severe triple vessel coronary artery disease and leaking abdominal aortic aneurysm is presented here. He was managed by combined coronary artery bypass graft surgery and prosthetic replacement of abdominal aortic aneurysm.

CASE REPORT The patient, an average built man of 54 years and a diagnosed case of CAD was referred for CABG in cardiac surgery out patient department on 3rd March 1998. He complained of progressively worsening effort angina for the last one year (CCS-II) with aggravation of symptoms for the last three months (CCS-III). There were no complaints suggesting any other significant medical or surgical illness. His vital signs were within normal limits. Systemic examination was unremarkable. ECG was suggestive of old inferior infarction. Exercise tolerance test was positive for ischemia in six minutes with 2mm ST depression in anterior and lateral chest leads. Echocardiogram showed moderate left ventricular functions and 45% ejection fraction with inferio-basal hypokinesia. Angiocardiography revealed severe triple vessel disease with critical lesions in proximal left anterior descending (LAD) and circumflex (CX) artery and totally blocked right coronary artery (RCA). Left ventricular end diastolic pressure was 18 mmHg. Patient was scheduled for CABG after three month. On 29th May patient reported with severe abdominal pain radiating to the back. Abdominal examination revealed a 4-6 cm globular pulsatile and tender swelling in the epigastric region. Patient was admitted and investigated. X-ray of the abdomen was normal. Abdominal ultrasonography revealed an infra-renal AAA with an anterio-posterior diameter of 6.2 cm, extending up to the aortic bifurcation. CT scan confirmed the presence of a 6.9-9.8 cm oblong in shape infra-renal AAA. Since patient had severe triple vessel CAD and a large AAA with clinical evidence of rapid enlargement of the aneurysm it was decided to simultaneously perform CABG and AAA replacement which was done on 6th June 1998.

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