[Combined surgical treatment of patients with multifocal atherosclerosis]

Multifocal manifestation of atherosclerosis (ATS) is common for this pathology and demands special diagnostic and therapeutic approaches. The need of active screening of basic clinical forms of multifocal ATS--carotid, peripheral arterial disease (PAD), aortic abdominal aneurysms(AAA) and coronary (IHD) is mandatory along with precise indications of therapeutical strategy and operative tactics in cases when surgical treatment is needed. The aim of this study is the evaluation of our results in operative treatment of combined forms of ATS and proper indication for simultaneous or two staged surgical approach. Our experience dictates simultaneous operative strategy only in cases of: 1. Carotid stenosis > 70% even asympthomatic, or > 50% sympthomatic stenosis (group A) combined with coronary artery disease in III-IV stage and 2-3 main vessel disease and unstable angina. 2. AAA > 7 cm. (group B) associated with IHD. 3. PAD with critical limb ischemia associated with unstable IHD. The absence of this specific indications allows not so aggressive surgical approach--two staged procedures (coronary artery bypass surgery first and several months later arterial reconstructive surgery of carotid or abdominal aortic lesions.