Coronary and major vascular disease: aggressive screening and priority-based therapy

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Interventional Cardiology

Background:

• Atherosclerosis frequently affects multiple vascular systems simultaneously.
• Managing patients with diffuse atherosclerosis presents challenges in preoperative and intraoperative care.

Purpose of the Study:

• To evaluate the prevalence of coronary artery disease (CAD) in patients with peripheral artery disease (PAD), and vice versa.
• To assess the effectiveness of aggressive screening and priority-based management strategies.

Main Methods:

• Study 1: 1,000 patients with abdominal aortic or carotid disease underwent CAD screening before surgery.
• Patients were stratified by risk, with tailored preoperative evaluations and priority-based surgical approaches.
• Study 2: 1,000 patients undergoing coronary angiography were screened for aortic and carotid disease.

Main Results:

• In Study 1, 15% of patients with PAD had significant CAD. Combined procedures showed low mortality (0.6-0.8%) and perioperative myocardial infarction rates (0.8-1.4%).
• In Study 2, 4.9% of patients with suspected CAD had correctable aortic disease, and 4% had correctable carotid disease.
• No in-hospital mortality or perioperative myocardial infarction occurred in Study 2 patients treated for combined coronary and vascular disease.

Conclusions:

• Aggressive screening and priority-based treatment are effective for managing patients with multi-system atherosclerosis.
• Combined surgical interventions for coronary and peripheral vascular disease can be performed safely with this approach.