Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.003515
Jornal Vascular Brasileiro
Original Article

Complicações cardíacas em cirurgia vascular

Cardiac complications in vascular surgery

Karla Scamardi Martins Pereira; Janaina Cenedes Prudente de Oliveira; Francine Correa de Carvalho; Bonno van Bellen

http://dx.doi.org/10.1590/1677-5449.003515 J Vasc Bras, vol.15, n1, p.16-20, 2016
PDF Português
PDF English
Downloads: 1
Views: 1372

Resumo

Resumo Contexto Aproximadamente 60% dos pacientes portadores de doença arterial oclusiva crônica periférica têm doença coronariana grave, sendo que a principal causa de morte no pós-operatório de cirurgia vascular de grande porte é o infarto agudo do miocárdio. Objetivos Determinar a prevalência da doença coronariana em pacientes submetidos a cirurgia vascular eletiva de grande porte e sua relação com as complicações cardiológicas pós-operatórias. Métodos Foram analisados 200 pacientes submetidos a cirurgia vascular arterial eletiva: doença obstrutiva carotídea, aortoilíaca e femoropoplítea distal e doença aneurismática de aorta abdominal e de artérias ilíacas. Os pacientes constituíram três grupos: grupo I, sem doença coronariana; grupo II, com doença coronariana assintomática; e grupo III, com doença coronariana sintomática. As complicações cardiológicas consideradas foram infarto agudo do miocárdio fatal e não fatal, insuficiência cardíaca congestiva, choque cardiogênico, fibrilação atrial aguda e outras arritmias. Resultados Complicações cardíacas ocorreram em 11 pacientes (5,5%): três infartos agudos do miocárdio não fatais (1,5%) sempre em pacientes do grupo III. A complicação cardíaca mais frequente foi arritmia (exceto fibrilação atrial) ocorrida em cinco (2,5%) pacientes, sendo três do grupo II. A mortalidade precoce foi de nove pacientes (4,5%). Apenas uma morte foi decorrente de problema cardíaco: choque cardiogênico em paciente do grupo III. Conclusões A doença coronariana não foi preditora de óbito nos pacientes submetidos a cirurgia vascular periférica de grande porte. A sobrevida dos pacientes com ou sem doença coronariana não mostrou diferenças estatísticas.

Palavras-chave

doenças vasculares periféricas, coronariopatia, cirurgia vascular, complicações pós-cirúrgicas

Abstract

Abstract Background Approximately 60% of patients with chronic occlusive peripheral arterial disease have severe coronary disease and the principal cause of death during the postoperative period after major vascular surgery is acute myocardial infarction. Objectives To determine the prevalence of coronary disease among patients scheduled for elective major vascular surgery and its relationship with postoperative cardiological complications. Methods A total of 200 patients who underwent elective vascular arterial surgery for obstructive carotid disease, aortoiliac and distal femoropopliteal disease and aneurysmal disease of the abdominal aorta and iliac arteries were analyzed. These patients were allocated to three groups: group I, free from coronary disease; group II, asymptomatic coronary disease; and group III, symptomatic coronary disease. The cardiological complications analyzed were fatal and nonfatal acute myocardial infarction, congestive heart failure, cardiogenic shock, acute atrial fibrillation and other arrhythmias. Results Cardiac complications occurred in 11 patients (5.5%): three nonfatal acute myocardial infarctions (1.5%), all in patients from group III. The most common cardiac complication was arrhythmia (excluding atrial fibrillation) in five (2.5%) patients, three from group II. Early mortality was nine patients (4.5%). Just one death was caused by a cardiac problem: cardiogenic shock in a patient from group III. Conclusions Coronary disease was not predictive of death among patients who underwent major peripheral vascular surgery. There were no statistical differences in survival between patients with or without coronary disease.

Keywords

vascular peripheral diseases, coronary disease, vascular surgery, postoperative complications

References

Sukhija R, Aronow WS, Yalamanchili K, Sinha N, Babu S. Prevalence of coronary artery disease, lower extremity peripheral arterial disease, and cerebrovascular disease in 110 men with an abdominal aortic aneurysm. Am J Cardiol. 2004;94(10):1358-9.

Maffei FH. Aterosclerose obliterante periférica: epidemiologia, fisiopatologia, quadro clínico e diagnóstico. Doenças vasculares periféricas. 2008.

Goessens BM, Visseren FL, Algra A, Banga JD, van der Graaf Y. Screening for asymptomatic cardiovascular disease with noninvasive imaging in patients at high-risk and low-risk according to the European Guidelines on Cardiovascular Disease Prevention: the SMART study. J Vasc Surg. 2006;43(3):525-32.

Dormandy JA, Rutherford RB. Management of Peripheral Arterial Disease (PAD). TASC Working Group. Transatlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000;31(1-2):13-5.

Mackey WC, Fleisher LA, Haider S. Perioperative myocardial ischemic injury in high-risk vascular surgery patients: Incidence and clinical significance in a prospective clinical trial. J Vasc Surg. 2006;43(3):533-8.

Eagle KA, Brundage BH, Chaitman BR. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery: report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery. Circulation. 1996;93(6):1278-317.

L´ Italien GJ, Paul SD, Hendel RC. Development and validation of a Bayesian model for perioperative cardiac risk assessment in a cohort of 1,081 vascular surgical candidates. J Am Coll Cardiol. 1996;27(4):779-86.

Mangano DT, Layug UL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med. 1996;335(23):1713-20.

Bredahl K, Jensen LP, Schroeder TV, Sillesen H, Nielsen H, Eiberg JP. Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease. J Vasc Surg. 2015;62(1):75-82.

Boabaid R, Martorell A, Lisbona C, Lerma R, Mejia S, Callejas JM. Análise dos resultados dos 100 primeiros aneurismas da aorta abdominal operados em um serviço de angiologia e cirurgia vascular. Arq Cat Med.. 1996;25:115-21.

Lee TH, Marcantonio ER, Mangione CM. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043-9.

Eagle KA, Rihal CS, Mickel MC. Cardiac risk of noncardiac surgery. influence of coronary disease and type of surgery in 3368 operations. Circulation. 1997;96(6):1882-7.

Bodenheimer MM. Noncardiac surgery in the cardiac patient: what is the question?. Ann Intern Med. 1996;124(8):763-6.

McFalls EO, Ward HB, Moritz TE. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004;351(27):2795-804.

Fleisher LA, Fleischmann KE, Auerbach AD. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(24):2215-45.

Carvalho FC, Brito VP, Tribulatto EC, van Bellen B. Estudo prospectivo da morbi-mortalidade precoce e tardia da cirurgia do aneurisma da aorta abdominal. Arq Bras Cardiol. 2005;84(4):292-6.

Ward RP, Min JK, McDonough KM, Lang RM. High prevalence of important cardiac findings in patients with peripheral arterial disease referred for echocardiography. J Am Soc Echocardiogr. 2005;18(8):844-9.

Krupski WC, Layug EL, Reilly LM, Rapp JH, Mangano DT. Comparison of cardiac morbidity rates between aortic and infrainguinal operations: two-year follow-up: study of Perioperative Ischemia Research Group. J Vasc Surg. 1993;18(4):609-15, discussion 615-7.

L’Italien GJ, Cambria RP, Cutler BS. Comparative early and late morbidity among patients requiring different vascular surgery procedures. J Vasc Surg. 1995;21(6):935-44.

Hertzer NR, Beven EG, Young JR. Coronary artery disease in peripheral vascular patients: a classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984;199(2):223-33.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5de6c2dc0e88256c33e3e9cf jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections