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Polyvascular Disease: Principles of Diagnosis and Management

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PanVascular Medicine

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Abstract

Polyvascular disease, 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. Polyvascular disease 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, polyvascular disease 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 biomarkers such as carotid intima–media thickness or indices of arterial stiffness may 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 polyvascular disease 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.

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Abbreviations

Ankle–brachial index:

It is the ratio of the blood pressure in the lower legs (posterior tibial artery or dorsalis pedis artery) to the blood pressure in the arms (brachial artery).

Arterial stiffness:

It is the (reduced) capability of an artery to expand and contract in response to pressure changes.

Polyvascular atherosclerosis:

The simultaneous presence of clinically relevant atherosclerotic lesions in at least two major vascular territories.

Pulse wave velocity:

It is the distance traveled (Δx) by the pressure wave divided by the time (Δt) taken by the wave to travel that distance.

Vascular biomarkers:

Biomarkers that originate from changes in function or structure of blood vessels such as aortic stiffness, carotid intima–media thickness, and endothelial function.

AAA:

Abdominal aortic aneurysm

ABI:

Ankle–brachial index

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CAS:

Carotid artery stenosis

CEA:

Carotid endarterectomy

cIMT:

Carotid intima–media thickness

CTA:

Computed tomography angiography

CV:

Cardiovascular

DM:

Diabetes mellitus

ICA:

Invasive coronary angiography

LOE:

Level of evidence

MRA:

Magnetic resonance angiography

PAD:

Peripheral artery disease: in this document the term refers to lower limb PAD unless otherwise specified

PCI:

Percutaneous coronary intervention

PWV:

Pulse wave velocity

RAS:

Renal artery stenosis

TIA:

Transient ischemic attack

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Author information

Authors and Affiliations

  1. Department of Cardiology, Peripheral Vessels and Hypertension Units, Athens Medical School, Athens, Greece

    Charalambos Vlachopoulos

  2. Department of Cardiology, University of Ioannina, Ioannina, Greece

    Katerina Naka

Authors
  1. Charalambos Vlachopoulos
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  2. Katerina Naka
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Corresponding author

Correspondence to Charalambos Vlachopoulos .

Editor information

Editors and Affiliations

  1. Division of Cardiovascular Disease Department of Internal Medicine, Health Care Center Bitterfeld, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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© 2015 Springer-Verlag Berlin Heidelberg

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Vlachopoulos, C., Naka, K. (2015). Polyvascular Disease: Principles of Diagnosis and Management. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37078-6_214

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  • DOI: https://doi.org/10.1007/978-3-642-37078-6_214

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-37077-9

  • Online ISBN: 978-3-642-37078-6

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