Polyvascular Disease: Principles of Diagnosis and Management

Abstract

Polyvasculardisease, defined as the simultaneous presence of clinically relevant atherosclerotic lesions in at least two major vascular territories, is found in about 15 % of patients with multiple cardiovascular risk factors or patients diagnosed with atherosclerotic disease at any site. Polyvasculardisease increases significantly the risk for myocardial infarction, cardiovascular death, and also stroke. The greater the number of arterial sites affected, the greater the risk of a major cardiac event. Despite its high incidence and much worse cardiovascular prognosis, polyvasculardisease has still not been well studied. The ankle–brachial index, the noninvasive marker of peripheral arterial disease, and imaging methods such as duplex ultrasound, computed tomography, or magnetic resonance angiography can be used for the diagnosis of atherosclerosis in various vascular beds, while invasive angiography is reserved mainly for endovascular treatment procedures. Other vascular biomarkerssuch as carotid intima–media thickness or indices of arterial stiffnessmay also be used to help identify patients at higher cardiovascular risk; further research is needed to establish their role in this group of patients. Secondary preventive measures and aggressive medical treatment should be initiated to reduce excess CV risk. Whether routine screening for polyvasculardisease in patients with risk factors or selected groups of patients with established disease in one site may alter treatment in order to improve outcome in these patients has not been adequately investigated. Clinical studies are needed to identify more effective ways to diagnose and treat these patients. However, the variability and complexity of clinical presentation in this setting will likely mandate individualized assessment and management of each patient within a highly skilled multidisciplinary medical team to optimize short-and long-term prognosis.