How should we investigate the arteriopath for coexisting lesions

The surgical techniques dealing with patients suffering from chronic arterial disease were developed during the first era of vascular surgery. Computerised tomography and other non-invasive screening techniques which were developed in the middle years has resulted in improved selection of patients for arteriography and surgery and has provided better means for study of the natural history of the disease. Latterly increased sophistication of these techniques has enabled us to detect and accurately assess asymptomatic arterial disease and to follow its development in the cerebrovascular, peripheral and coronary arterial circulation. This has resulted in a better understanding of risk factors involved both in the presenting lesion and in the circulation in general. From the latter point of view since the surgical management of ischaemic heart disease has improved so dramatically in the last 15 years, it is felt that a greater degree of success should be obtained in patients undergoing peripheral vascular reconstructive surgery. It is suggested therefore that adequate evaluation of the cardiac and cerebrovascular status of patients suffering from peripheral vascular disease should help to improve the overall prognosis and it is the object of this paper to set out the ways and means in which this might be achieved.