This patient presented for cardiac catheterization as part of preoperative evaluation prior to repair of a large abdominal aortic aneurysm. While not symptomatic with heart disease , he has multiple risk factors for coronary artery disease. The aneurysm is quite large and exceeds 6 cm- a value linked with increased risk for aneurysm rupture.

Angiography showed severe multivessel coronary disease including 80-90% stenosis (narrowing) of the distal left main (arrow) and total occlusion of the proximal right coronary artery. Because of the large aneurysm with laminated thrombus, he was not a candidate for balloon pump counterpulsation. Luckily, his left ventricular function was well preserved. He underwent emergent aortocoronary bypass grafting (open heart surgery) uneventfully and later had successful repair of the aneurysm.

This patient demonstrates the diffuse nature of vascular disease . As in many cases, vascular disease is not limited to one vascular territory but extends throughout the body . In this case, there is peripheral vascular disease affecting the abdominal aorta and iliac system in addition to critical coronary disease.

Risk factors for abdominal arotic aneurysms are similar to those for coronary disease. Family history of an aneurysm particularly in hypertensive patients also identifes patients at increased risk.