[Clinical approach to the patient with polyvascular disease]

The history and the physical examination are important steps in the clinical approach to the polyvascular patient. They are the foundation of a rational diagnostic and therapeutic management. Complementary investigations are nevertheless necessary. Ultrasonography has become an essential complement to the physical examination. Its field covers all peripheral vessels: supra-aortic arteries, aorta and its branches, limb arteries. The ultrasound are applied following continuous and pulsed Doppler and real time echography. The two methods may be combined (duplex echography). The investigations are performed first at rest, but assessments under strain are often necessary. The cardiac examination has been enriched by modern methods: thallium scintigraphy under dipyridamole is specially useful in order to measure the coronary reserve. Angiographic images are still a must for most of the aggressive therapeutic decisions. The modern techniques are more flexible using digitalization and a suitable investigation is chosen in function of each individual condition.