B.G. AlekyanA.V. Vishnevsky National Medical Research Center of Surgery, Russian Federation
Title: A multidisciplinary approach in assessing the prevalence of coronary artery disease and selecting treatment strategies in patients with aortic and peripheral artery diseases
Aim: To assess the prevalence of CAD and select optimal treatment strategies in patients with aortic and peripheral artery diseases using the multidisciplinary approach.
Material and methods: 693 patients present with aortic and peripheral artery diseases were recruited. Of them, 171 (32.5%) were female, and 522 (75.3%) were male. The mean age of patients was 67.2+8.8 years. 32.5% of patients (n=223) were older than 71 years. 203 (29.3%) patients were symptomatic, whereas 490 (70.7%) were asymptomatic. 196 (28.3%) patients had an isolated lesion of the internal carotid artery (ICA). 93 (13.4%) patients had a combined lesion of the ICA and lower limb arteries, 70 (10.1%) and 60 (8.6%) patients had a combined lesion of the iliac and superficial femoral arteries, and femoral arteries lesions, respectively.
Results. 554 (79.9%) of 693 patients had lesions of at least one lumen diameter stenosis of ?50%. Of them, 368 (66.4%) patients were clinically asymptomatic. By the decision of the multidisciplinary heart team, 316 (57.0%) patients underwent myocardial revascularization: 21 (6.7%) — coronary artery bypass grafting, and 295 (50.3%) — percutaneous coronary intervention. Surgical and endovascular interventions for aortic and peripheral artery diseases were performed in 486 (70.1%) patients. 226 (46.5%) patients required vascular surgery in addition to myocardial revascularization. A total of 923 surgeries (564 endovascular and 359 open-heart surgeries) were performed in 580 patients in the in-hospital period. Three (0.51%) patients died. Two (0.56%) patients had stroke following ICA grafting and ICA thrombosis after carotid endarterectomy. In-hospital acute myocardial infarction was not detected in any of the patients.
Conclusion. 79.9% of patients with aortic and peripheral artery diseases had at least at least one lumen diameter stenosis of ?50%. 66.4% of patients with aortic and peripheral artery disease and coronary artery stenotic lesions over 50% did not have any complaints. 45.6% of patients admitted to the hospital with atherosclerotic lesions of the aorta and peripheral arteries required myocardial revascularization. A multidisciplinary approach is an effective and safe management strategy for patients with aortic and peripheral artery disease and concomitant CAD.