Risk of cardiac surgery in patients with peripheral vascular disease

After reading these articles, I think the evidence is convincing that peripheral vascular disease clearly places the patient at a higher risk for coronary bypass surgery than is the case for patients without peripheral vascular disease. However, in some instances coronary bypass surgery must be performed before peripheral vascular surgery is performed. Perhaps the best way to leave it is to indicate that if there is a clear-cut indication for coronary bypass surgery it should be done independent of vascular disease elsewhere, but one must accept the fact that most reports indicate an increased morbidity and mortality. Thus, I would like to make a final point by quoting Gersh: "The protective shield of prior coronary artery bypass surgery [in patients with peripheral vascular disease] . . . has a price."