Peripheral vascular disease endovascular management in patients scheduled for cardiac surgery: a clinical-angiographic approach Gianluca Rigatelli 1,2 , Paolo Cardaioli 1 , Massimo Giordan 1 , Loris Roncon 1 , Giuseppe Faggian 3 , Giorgio Rigatelli 2,4 & Pietro Zonzin 1 1 Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Rovigo, Italy; 2 Endocardiovascular Therapy Research, Legnago, Verona, Italy; 3 Department of Cardiovascular Surgery, University of Verona Medical School, Verona, Italy; 4 Division of Cardiology, Department of Specialistic Medicine, Legnago General Hospital, Verona, Italy Received 20 September 2005; accepted in revised form 4 December 2005 Key words: antiplatelets drugs, angioplasty, endovascular stent, peripheral vascular disease Abstract Backgrounds: Endovascular management of peripheral vascular disease before cardiac surgery is still de- bated. We sought to present our preliminary experience of endovascular stent placement in patients scheduled for urgent cardiac surgery. Methods: Between November 2003 and August 2005, 20 patients scheduled for urgent coronary surgery (13 males, mean age 72.5±5.3 years) underwent endovascular repair of PVD on the basis of clinical and angiographic indications. Aspirin (100 mg/day) plus low molecular weight heparin (nadroparin calcium) 100 IU/kg/12 h for urgent coronary surgical revascularization was administered after the procedure. Results: Endovascular stenting has been performed in four clinical set- tings: renal artery stenting prior to coronary surgery (nine patients) to decrease the impact of extracor- poreal circulation on an impaired renal function, iliac artery artery angioplasty and stenting (eight patients) in order to facilitate aortic balloon pump insertion after surgery, subclavian artery angioplasty and stenting propedeutical to arterial conduits bypass surgery (one patient), carotid artery stenting before coronary surgery (two patients). All patients underwent successful endovascular repair followed by cardiac surgery. At a mean follow-up of 12±4.6 months all patients are alive and without evident thrombosis or restenosis of the implanted vascular stents. Conclusions: Endovascular treatment of PVD in patients scheduled for urgent coronary surgery may be effective, relatively safe and lasting in spite of low dose antiplatelet regimen. Introduction Patients with peripheral vascular disease (PVD) undergoing coronary revascularization have a high rate of adverse outcome since diabetes, chronic renal dysfunction, old age and PVD greatly affect survival after both coronary surgery and percuta- neous revascularization [1, 2]. Endovascular management of PVD in patients scheduled for cardiac surgery is still debated, because the indi- cations in this class of patients are unclear and the antiplatelet regimen required after percutaneous peripheral interventions may cause excessive bleeding in patients scheduled for cardiac surgery [3, 4]. We sought to present our experience of en- dovascular stent placement in patients scheduled The International Journal of Cardiovascular Imaging (2006) 22: 305–310 Ó Springer 2006 DOI 10.1007/s10554-005-9065-4