Is Angiography Safe in Aortic Aneurysm Patients with CAD?

Zachary M. Gertz, MD
Director of Structural Heart Disease, VCU Pauley Heart Center
Assistant Professor, VCU School of Medicine

Because of our center’s high surgical volume with ascending aortic aneurysms, we have performed coronary angiography on a large cohort of these patients. Over time, we came to use a JL catheter that matched the aneurysm size, and had good success. Planning for the right coronary was more difficult, as the catheters were less predictable, although we did find that certain aneurysm locations and shapes conferred a more superior or inferior direction of the coronary artery take-off. We found that there was little in the literature to guide us in approaching this procedure, and that was the impetus for this study.

Also of interest was the incidence of coronary artery disease. An interesting comparison is with patients with abdominal aortic aneurysms, about whom more is known in terms of risk factors and disease presence. Ascending aneurysms arise from a different pathophysiology than abdominal aortic aneurysms, which typically occur because of atherosclerotic vessel destruction. A low incidence of coronary disease in the ascending aneurysm population might argue against routine catheterization. Yet the incidence of coronary disease was not trivial. As long as a sternotomy is part of the operative procedure for ascending aortic aneurysm repair, we feel that the relative ease of catheterization, coupled with the prevalence of coronary disease, justify the continued practice of preoperative catheterization in this population.

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