Endovascular intervention in patients with coronary and peripheral arterial disease

Randomized clinical trials have typically demonstrated lower mortality rates for patients with coronary artery disease who participate in cardiac rehabilitation programs. The Multiple Risk Factor Intervention Trial, the Lifestyle Heart Trial, and the Aerobics Research Institute studies suggest that light to moderate amounts of exercise protect against early mortality from coronary artery disease. Walking is the cornerstone of cardiovascular rehabilitation. Patients with coronary artery disease who are limited by claudication may be unable to participate in their cardiovascular exercise program. In a subset of patients with combined coronary and peripheral arterial disease who have had failure with an oral hemorrheologic agent (Pentoxifylline) and an aggressive walking program, claudication is an indication for diagnostic angiography and revascularization. Percutaneous endovascular interventions that enable these patients to enroll in cardiac rehabilitation programs may favorably influence their long-term outcome. Selected case studies are used to illustrate this management approach for these patients who are at high risk.