Assessment of Carotid Artery Stenosis and Lower Limb Peripheral Ischemia Prior to CABG
Assessment of Carotid Artery Stenosis and Lower Limb Peripheral Ischemia Prior to CABG
From our experience among Egyptian population in our institution, there is an increased
 prevalence of hidden subclinical peripheral artery disease along with carotid artery
 affection. Thus, increasing the risk of post-operative morbid complications.We aim to
 evaluate routine/ non-selective carotid and peripheral arterial screening in asymptomatic
 patients undergoing coronary artery bypass grafting in the Egyptian populationIt is a
 prospective, non-randomized, comparative study including two groups of patients. The study
 will start from the day of approval of the ethical committee. It will include 260 patients,
 on basis of "all new comers". Patients will be examined and classified as "high-risk" group
 (ɳ = 130) or "low-risk" group (ɳ=130).

 All patients will have the "routine" preoperative investigations along with evaluation of
 extracranial carotid system by non-invasive carotid duplex and lower limb arterial system by
 non-invasive bilateral lower limb arterial duplex.
Inclusion Criteria:

 1. The acceptance of the patients to participate in the study in the form of a written
 consent.

 2. Patients of both sexes.

 3. Three vessels disease for CABG.

 4. Patients' age: from 35 to 75 years old.

 5. Elective, isolated, primary cases of CABG.

 6. Patients with ejection fraction above 40%.

 7. Inclusion criteria for the high-risk group will include:

 1. Patients with preoperative history of cerebrovascular events or symptoms
 suggestive of CVS eg.TIA, transient blindness in one eye, Dizziness, Confusion,
 Drowsiness, Headache, Temporary inability to speak or move.

 2. Carotid bruit

 3. Left main stem coronary artery disease

 4. Presence of other peripheral vascular disease

 Exclusion Criteria:

 1. Patients refusing to participate in the study.

 2. Age 76 years or above

 3. Morbid obese patients (body mass index more than 35).

 4. Patients who underwent coronary stenting before.

 5. Patients who underwent previous cardiac operation before.

 6. Patients with impaired renal functions (serum creatinine > 1.5 mg/dl, blood urea > 100
 mg/dl and K+ > 5 meq/L).

 7. Patients with preoperative hemoglobin < 9 gm/dl, white blood cells > 15,000
 cells/mcl,platelets count < 140,000 per microliter.

 8. Patients with rhythm defects by electrocardiography (ECG).

 9. Patients with preoperative O2 saturation < 90 % by pulse oximetry.