Title:Patients with Polyvascular Disease: A Very High-risk Group
Volume: 20
Issue: 6
Author(s): Antonis A. Manolis, Theodora A. Manolis and Antonis S. Manolis*
Affiliation:
- School of Medicine, Athens University, Athens, Greece
Keywords:
Polyvascular disease, coronary artery disease, peripheral artery disease, carotid disease, abdominal aortic aneurysm, atherosclerosis, cardiovascular outcomes, major adverse cardiovascular events.
Abstract: Polyvascular disease (PolyvascDis) with atherosclerosis occurring in >2 vascular beds (coronary,
carotid, aortic, visceral and/or peripheral arteries) is encountered in 15-30% of patients who experience
greater rates of major adverse cardiovascular (CV) events. Every patient with multiple CV risk
factors or presenting with CV disease in one arterial bed should be assessed for PolyvascDis clinically
and noninvasively prior to invasive angiography. Peripheral arterial disease (PAD) can be readily diagnosed
in routine practice by measuring the ankle-brachial index. Carotid disease can be diagnosed by
duplex ultrasound showing % stenosis and/or presence of plaques. Coronary artery disease (CAD) can
be screened by determining coronary artery calcium score using coronary computed tomography angiography;
further, non-invasive testing includes exercise stress and/or myocardial perfusion imaging or
dobutamine stress test, prior to coronary angiography. Abdominal ultrasound can reveal an abdominal
aortic aneurysm. Computed tomography angiography will be needed in patients with suspected mesenteric
ischemia to assess the mesenteric arteries. Patients with the acute coronary syndrome and concomitant
other arterial diseases have more extensive CAD and poorer CV outcomes. Similarly, PolyvascDis
in patients with carotid disease and/or other PAD is independently associated with an increased risk for
all-cause and CV mortality during long-term follow-up. Treatment of patients with PolyvascDis should
include aggressive management of all modifiable risk factors by lifestyle changes and drug therapy,
with particular attention to patients who are commonly undertreated, such as those with PAD. Revascularization
should be reserved for symptomatic vascular beds, using the least aggressive strategy in a
multidisciplinary vascular team approach.
