Letter to the Editor Unusual combination of coronary artery, abdominal aortic and iliac artery inflammatory aneurismal disease Gianluca Rigatelli a, * , Marzio Gemelli b , GianFranco Franco b , Alvise Menini c , Giorgio Rigatelli c a EndoCardioVascular Therapy Research, Via T.Speri 18, 37040 Legnago, Verona, Italy b Cardiovascular Catheterization Laboratory, ‘‘Brain, Heart and Kidney’’ Department, Legnago Teaching Hospital, Via T.Speri 18, 37040 Legnago, Verona, Italy c Vascular Surgery Division, Department of Surgery, Legnago Teaching Hospital, Via T.Speri 18, 37040 Legnago, Verona, Italy Received 27 December 2002; accepted 2 April 2003 The presence of coronary artery aneurysm (CAA) is revealed in 1–4% of coronary angiography [1] but the association with aortic abdominal aneurysm (AAA) is only anedoctical [2]. Atherosclerosis in 50%, and more rarely Marfan disease [3], and Kawasaki disease [4] are considered the main causes of coronary aneurysms, while atheroscle- rosis in 80% and inflammation in 3 – 10% of cases constitute practically the main ethiologies of aortic abdominal aneur- ysms. No association of CAA and inflammatory AAA has been reported so far. We present a case of CAA and inflammatory AAA in which staged surgical treatment of both diseases was per- formed instead of endovascular management. A 51-year-old white caucasian man with a history of high blood pressure and smoke was admitted to our center for an acute antero-lateral myocardial infarction. Physical examination revealed an exaggerated pulsating abdominal mass. Laboratory tests showed a increased eryth- rocite sedimentation rate and elevated C-reactive protein values. Echocardiography detected a low left ventricular ejec- tion fraction (37%) and anterolateral akinesis with ventric- ular aneurysm. The substernal projection revealed an enlargement of the abdominal aorta suggesting an aortic aneurysm. The patient underwent coronary angiography that revealed multiple aneurysms and occlusive disease of both the left and right coronary arteries (Fig. 1A–B), while aortography revealed the presence of a voluminous aortic abdomino-iliac aneurysm (Fig. 2A–B). The angio-CT confirmed a large aortic abdominal aneu- rysm of >8 cm in diameter with true lumen of 6 cm and revealed an insufficient neck for conventional endovascular repair ( < 1.5 cm), the involvement of both the common iliac arteries and a hydro-ureteronephrosis due to compression by the common iliac artery. The patient underwent a dypiridamole-echo stress that suggested the presence of induced ischemia in both lateral and apical regions. The patient was surgically managed with myocardial revascularization of both coronary arteries using the LIMA for the left coronary artery and a saphein graft for the right one. Histological examination of the surgical sample confirmed the inflammatory nature of the abdom- inal aneurysm. Subsequently open repair of both aortic and iliac aneur- ismal disease was successfully accomplished. At 2-year follow-up no signs of increase in periaortic fibrosis has been observed at further CT interrogation. Our case presented all the typical characteristics of inflammatory disease: high ESR, high level of C-reactive protein and compression of the ureter were present as described in literature [5]. A common ethiology for both coronary and aortic aneurysms could be postulated, despite there being no history of Kawasaki or Bechet or Rheumathoid Arthritis or other systemic inflammatory disease, but there were clear cardiovascular risk factors. We though that a unique inflammatory ethiology was a real possibility because the angiographic appearance of coronary disease was not typical for atherosclerotic process but more 0167-5273/$ - see front matter D 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2003.04.051 * Corresponding author. ECVTR Via T.Speri 18, 37040, Legnago, Verona, Italy. Tel.: +39-44-2632-329; fax: +39-44-2632-311. E-mail address: jackyheart@hotmail.com (G. Rigatelli). www.elsevier.com/locate/ijcard International Journal of Cardiology 96 (2004) 105 – 107