Patients with Polyvascular Disease: A Very High-risk Group

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Diagnostic Imaging

Background:

• Polyvascular disease (PolyvascDis), defined by atherosclerosis in more than two vascular beds, affects 15-30% of patients and is linked to higher rates of major adverse cardiovascular events.
• Patients with multiple cardiovascular risk factors or existing disease in one arterial bed require assessment for PolyvascDis before invasive procedures.

Purpose of the Study:

• To highlight the prevalence and clinical significance of polyvascular disease.
• To emphasize the importance of early clinical and noninvasive diagnosis of PolyvascDis.
• To outline current diagnostic modalities and treatment strategies for PolyvascDis.

Main Methods:

• Review of diagnostic approaches for peripheral arterial disease (PAD) using ankle-brachial index.
• Description of carotid artery disease diagnosis via duplex ultrasound.
• Outline of coronary artery disease (CAD) screening using coronary computed tomography angiography and non-invasive stress testing.
• Mention of abdominal aortic aneurysm detection via abdominal ultrasound and mesenteric artery assessment with CT angiography.

Main Results:

• PolyvascDis is associated with more extensive CAD and poorer outcomes in acute coronary syndrome patients.
• PolyvascDis, particularly with carotid disease or PAD, independently increases all-cause and cardiovascular mortality.
• Aggressive risk factor management is essential for all patients with PolyvascDis, especially those with PAD.

Conclusions:

• Early assessment and diagnosis of PolyvascDis are critical for identifying high-risk patients.
• Comprehensive management of modifiable risk factors is paramount.
• Revascularization should be reserved for symptomatic disease within a multidisciplinary team approach.