Management of Patients with Poly-Vascular Disease: Priorities for Revascularization Procedures

Marco      De Carlo; Leonardo      Misuraca

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.

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