Bekos C, Pieri L, Angelides N, Moros I
First Clinic of Thoracic and Cardiovascular Surgery, Division of Vascular Surgery, AHEPA University Hospital, Thessaloniki, Greece.
Int Angiol. 2008 Oct;27(5):419-25.
Multifocal atherosclerotic disease or multifocal ischemic pathology (MAD) is an issue gaining a lot of attention by clinicians in recent years, due to its high impact on the morbidity and mortality of vascular patients. The coexistence of coronary artery disease (CAD), peripheral arterial disease (PAD) and carotid disease (CS) is being investigated in this study.
The study included 556 consecutive inpatients who were admitted to the Nicosia General Hospital in Cyprus for carotid endarterectomy, peripheral arterial reconstruction or coronary artery bypass. All patients were subjected to color duplex examination of the carotid vessels and to lower extremity Doppler study. Cardiac risk screening was performed on patients with PAD and CS. Comorbidity was evaluated by using the Cumulative Illness Rating Scale (CIRS).
The prevalence of MAD in atherosclerotic patients was found very high (60.3%). The most frequent comorbidity was the coexistence of PAD and CAD (41.8%). The comorbidity burden of MAD patients, in comparison to that of patients with unifocal atherosclerotic disease, was evaluated to conclude that the burden in the first group (MAD) is significantly higher, not only in relation to the number of clinically relevant diseases that co-exist, but also to the severity of these diseases. Furthermore, functional status is negatively affected by the existence of multifocal ischemic pathology.
The high prevalence of MAD suggests the necessity of developing a systematic screening approach in the everyday practice. Apart from cardiovascular problems, other diseases affect the clinical situation of these patients. Therefore, it is important to investigate these problems pre- and postoperatively.
多灶性动脉粥样硬化疾病或多灶性缺血性病变（MAD）近年来受到临床医生的广泛关注，因为它对血管疾病患者的发病率和死亡率有很大影响。本研究旨在调查冠状动脉疾病（CAD）、外周动脉疾病（PAD）和颈动脉疾病（CS）的共存情况。
该研究纳入了556例连续入住塞浦路斯尼科西亚综合医院接受颈动脉内膜切除术、外周动脉重建术或冠状动脉搭桥术的住院患者。所有患者均接受了颈动脉彩色双功超声检查和下肢多普勒检查。对患有PAD和CS的患者进行心脏风险筛查。采用累积疾病评定量表（CIRS）评估合并症。
发现动脉粥样硬化患者中MAD的患病率非常高（60.3%）。最常见的合并症是PAD和CAD共存（41.8%）。对MAD患者与单灶性动脉粥样硬化疾病患者的合并症负担进行评估后得出结论，第一组（MAD）的负担明显更高，不仅与共存的临床相关疾病数量有关，还与这些疾病的严重程度有关。此外，多灶性缺血性病变的存在对功能状态有负面影响。
MAD的高患病率表明在日常实践中需要制定系统的筛查方法。除心血管问题外，其他疾病也会影响这些患者的临床状况。因此，术前和术后对这些问题进行调查很重要。
