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ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery)

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to update the 1999 guidelines for coronary artery bypass graft surgery)

In an attempt to reduce early and late mortality caused by myocardial infarction, coronary angiography was performed in 1000 patients (mean age, 64 years) under consideration for elective peripheral vascular reconstruction since 1978. Those found to have severe, surgically correctable coronary artery disease (CAD) were advised to undergo myocardial revascularization (CABG), usually preceding other vascular procedures. The primary vascular diagnosis was abdominal aortic aneurysm (AAA) in 263 patients (mean age, 67 years), cerebrovascular disease (CVD) in 295 (mean age, 64 years), and lower extremity ischemia (ASO) in 381 (mean age, 61 years). Severe correctable CAD was identified in 25% of the entire series (AAA, 31%; CVD, 26%; and ASO, 21%). Surgical CAD was documented in 34% of patients suspected to have CAD by clinical criteria (AAA, 44%; CVD, 33%; and ASO, 30%) and in 14% of those without previous indications of CAD (AAA, 18%; CVD, 17%; and ASO, 8%). Cardiac procedures (216 CABG) were performed in 226 patients (AAA, 30%; CVD, 22%; and ASO, 19%), with 12 (5.3%) postoperative deaths. A total of 796 patients underwent 1066 peripheral vascular operations with an early mortality of 2.0% (AAA, 3.4%; ASO, 1.9%; and CVD, 0.3%), but only one death (0.8%) occurred in the group of 130 patients having preliminary CABG. The overall operative mortality for 1292 cardiac and peripheral vascular procedures was 2.6%.

Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management.

A classification is proposed that unifies and organizes spinal and cranial dural arteriovenous fistulous malformations (AVFMs) into three types based upon their anatomical similarities. Type I dural AVFMs drain directly into dural venous sinuses or meningeal veins. Type II malformations drain into dural sinuses or meningeal veins but also have retrograde drainage into subarachnoid veins. Type III malformations drain into subarachnoid veins and do not have dural sinus or meningeal venous drainage. The arterial supply in each of these three types is derived from meningeal arteries. The anatomical basis of the proposed classification is presented with several cases that illustrate the three types of dural AVFMs. A rationale for the treatment of spinal and cranial dural AVFMs according to their anatomical characteristics is discussed.

A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment

Surgical management of dissecting aneurysms of the aorta.

Surgical considerations of occlusive disease of innominate, carotid, subclavian, and vertebral arteries.

Aneurysm of Abdominal Aorta Analysis of Results of Graft Replacement Therapy One to Eleven Years After Operation

Cerebral arterial insufficiency: one to 11-year results following arterial reconstructive operation.

Fusiform aneurysm of the ascending aorta is a common form of aortic disease and is associated with a grave prognosis. Although excisional therapy is now established as the method of choice for aneurysms of the aorta, this form of treatment for aneurysms of the ascending aorta has been limited until the present time to sacciform lesions in which the neck is relatively small. In such instances tangential excision of the aneurysm with lateral aortorrhaphy may be curative if the adjacent aortic wall is not also involved by the degenerative process. In fusiform aneurysms and in most extensive sacciform lesions this method of treatment cannot be utilized and segmental resection of the ascending aorta with homograft replacement is necessary. Because of the fatal consequences from even brief occlusion of the ascending aorta, no aneurysm in this anatomic location has been treated successfully by segmental aortic resection. This report is concerned with

Resection of entire ascending aorta in fusiform aneurysm using cardiac bypass.

Carotid-subclavian bypass has been employed in the treatment of cerebrovascular insufficiency, upper extremity claudication, or a combination of these syndromes in 125 patients. All patients were studied angiographically prior to operation with either bilateral carotid and subclavian puncture or retrograde aortic arch injection. Indications for carotid subclavian bypass operation included: upper extremity claudication, twenty-one cases; symptoms of vertebrobasilar insufficiency, forty-nine cases; upper extremity claudication combined with symptoms of vertebrobasilar insufficiency, subclavian steal syndrome, and brachial-basilar insufficiency syndrome, thirty cases; symptoms of cerebrovascular insufficiency due to an obstructing lesion at the origin of the carotid arteries, twentyfive cases. Left carotid-subclavian bypass was employed in ninety-one patients (72 per cent) and right carotid -subclavian bypass in twenty (16 per cent). In fourteen patients (11 per cent) thromboendarterectomy of the common carotid bifurcation accompanied the carotid-subclavian bypass. There was an operative mortality of 4.8 per cent in this series of 125 patients. Follow-up studies obtained on all patients extending from nine months to fourteen years have demonstrated the effectiveness of this method of operative treatment.

Michael E. De Bakey

Papers

Surgical considerations of occlusive disease of innominate, carotid, subclavian, and vertebral arteries.

Aneurysm of Abdominal Aorta Analysis of Results of Graft Replacement Therapy One to Eleven Years After Operation

Cerebral arterial insufficiency: one to 11-year results following arterial reconstructive operation.

Resection of entire ascending aorta in fusiform aneurysm using cardiac bypass.

Occlusive disease of the common carotid and subclavian arteries treated by carotid-subclavian bypass