Thomas D
Service de Cardiologie, Hôpital de la Salpêtrière, Paris.
Ann Cardiol Angeiol (Paris). 1992 Dec;41(10):565-70.
Concomitant coronary and peripheral lesions are common, in particular in candidates for peripheral surgery. Coronary lesions dominate the prognosis in all cases. The later mid- and long-term risks of such associations is far greater than the immediate operative risk. Each type of surgery, peripheral or coronary, offers the opportunity for arterial evaluation of the other area in its own right, rather than because of the surgical context. No invasive investigations should be routine. The diagnostic approach is guided by clinical data and to a lesser degree by non-invasive investigations, the discriminant nature of which is unfortunately poor in the context of coronary evaluation. Indications for multifocal simultaneous or sequential revascularization procedures, by surgery or angioplasty, are in fact small in number. They are wide ranging and must be discussed case by case, taking into account age, general condition, the emergency context and the type and severity of lesions.
冠状动脉和外周血管病变常同时存在，尤其是在外周血管手术候选患者中。在所有病例中，冠状动脉病变主导预后。此类联合病变的中远期风险远大于即刻手术风险。外周血管或冠状动脉的每种手术类型本身都提供了评估另一区域动脉的机会，而非由于手术背景。不应将侵入性检查作为常规操作。诊断方法以临床数据为导向，在较小程度上受非侵入性检查引导，遗憾的是，在冠状动脉评估背景下，非侵入性检查的鉴别能力较差。事实上，通过手术或血管成形术进行多部位同步或序贯血运重建的适应证数量较少。这些适应证范围广泛，必须逐例讨论，同时考虑年龄、一般状况、紧急情况以及病变的类型和严重程度。
