[HSF] AAA and CABG

[John Schor]

I disagree with Mitch on the timing of AAA repair. 7 cm AAA post op  
from CABG is at high risk for rupture in my opinion. If an EVAR  
candidate I would do this no later than post op day 4-5, possibly even  
at the same setting as the CABG--if all goes well.
If EVAR not appropriate, consider sooner rather than later (2-4 wks).

There is no worse feeling for you or the pt's family than for rupture  
to occur while "waiting".

I agree with Mitch on the Passover wishes.
John


John Schor, MD
Verde Valley Medical Center
Cottonwood, AZ
Tel: 928-649-2584

On Apr 14, 2008, at 3:33 PM, Mitch Lirtzman wrote:

> Dr. Sharoni,
> First, I would evaluate for EVAR. If the patient is a candidate, and  
> the AAA is asymptomatic, I would wait 2-4 weeks post op. Definitely  
> do the CABG first. Keep him happy and stable. If not an EVAR  
> candidate, 6 weeks. In these instances, I continually reinforce to  
> patient and reassure the family the importance of observing for  
> symptoms. ANY abdominal, back or flank pain that is not related to  
> last night's burrito (perhaps not in Israel), they need to get to  
> the nearest ER, if not mine, and have the doc call me directly and  
> "I will operate on the patient any time, day or night".  Though  
> these folks are known to be at higher risk for post op rupture, that  
> has not been my experience.
>
> Happy Pesach.
>
> Mitch LirtzmanAt 02:55 PM 4/14/2008, you wrote:
>> Dear Colleagues,
>> I remember this was a discussed issue once - looking for a  
>> reference about
>> timingg of  CABG operation in a 7 cm AAA - before, after -  
>> concomitant?
>> We have a Pt with a 7 cm AAA who was sent by anaesthesia for a cath  
>> based on
>> abnormal perfusion scan (cleared by cardiology for operation based  
>> on this
>> scan) sure enough - TVD - needs CABG.
>> Needs some urgent answers Based on the literature and personal  
>> experience.
>> Thanks in advance
>> Erez Sharoni
>> Israel
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