Title:Management of Patients with Poly-Vascular Disease: Priorities for Revascularization Procedures
VOLUME: 10 ISSUE: 6
Author(s):Marco De Carlo and Leonardo Misuraca
Affiliation:Emodinamica, Ospedale Cisanello, via Paradisa 2, 56124 Pisa, Italy.
Keywords:Multisite artery disease, atherosclerosis, carotid artery stenosis, coronary artery disease, lower extremity artery disease,
revascularization, carotid artery stenting, carotid endarterectomy, coronary artery bypass grafting, percutaneous coronary
intervention, peripheral angioplasty, peripheral artery bypass, multi-disciplinary, guidelines, vascular team
Abstract:Multisite artery disease (MSAD) affects 15% to 30% of patients with clinically manifest atherosclerosis, and
has a relevant negative impact on prognosis. However, studies specifically focused on MSAD are very few, and available
evidence is scarce. Importantly, patients with MSAD require an integrated management, possibly by a "Vascular Team"
composed of the different specialists involved in the treatment of atherosclerosis. A multi-disciplinary, patient-centered
approach is mandatory to deal with the variety of clinical scenarios and comorbidities found in MSAD patients. The
risk/benefit ratio for multi-site arterial revascularization should always be carefully assessed in MSAD patients, taking
into account the additional risks of interventions in this subset of patients. Many therapeutic options have been proposed
for multisite revascularization, but little evidence is currently available to support specific recommendations. Percutaneous
revascularization of the different arterial districts, when feasible, appears promising because of the lower operative
morbidity and mortality.
