Modern approaches to the treatment of patients with abdominal aortic aneurysm and multifocal atherosclerosis

The surgical management of patients with abdominal aortic aneurysm (AAA) and concomitant severe cardiovascular diseases can be tough and are the subject of controversy among cardiovascular surgeons. It has been shown that concomitant lesions increase the morbidity and mortality in a postoperative period among high-risk patients. Due to the lack of clear recommendations regarding the treatment modality and timing of the surgical management are the cause of disagreements between treatment providers. Coronary artery disease (CAD) and carotid artery stenosis (CAS) are common in patients with abdominal aortic aneurysms. In this group patients, aortic cross-clamping may have a detrimental effect on cardiac function and can cause a stroke whereas coronary artery bypass graft surgery before aneurysmectomy (staged operation) carries the risk of the perioperative aneurysm rupture. Some authors advocate performing a staged approach: aortic surgery after thorough preoperative preparation and the second stage is carotid and coronary artery revascularization. Others recommend performing coronary artery and carotid artery revascularization first. In addition to this, there are disagreements about the timing of the aortic surgery as a second stage. Taking into account the risks of the staged approach some authors advocate a combined one-stage approach. This article also summarizes non-standard approaches to the treatment of patients with coexistent AAA and cardiovascular diseases. Due to the small number of articles on this topic, small sample size and various statistical methods in the available studies, it is not possible to propose the most optimal treatment modality. Randomized controlled studies with higher sample sizes should be conducted to determine an optimal treatment.