School of Medicine, Patras University, Patras, Greece.
School of Medicine, Athens University, Athens, Greece.
Curr Vasc Pharmacol. 2022;20(6):475-490. doi: 10.2174/1570161120666220912103321.
Polyvascular disease (PolyvascDis) with atherosclerosis occurring in >2 vascular beds (coronary, carotid, aortic, visceral and/or peripheral arteries) is encountered in 15-30% of patients who experience greater rates of major adverse cardiovascular (CV) events. Every patient with multiple CV risk factors or presenting with CV disease in one arterial bed should be assessed for PolyvascDis clinically and noninvasively prior to invasive angiography. Peripheral arterial disease (PAD) can be readily diagnosed in routine practice by measuring the ankle-brachial index. Carotid disease can be diagnosed by duplex ultrasound showing % stenosis and/or presence of plaques. Coronary artery disease (CAD) can be screened by determining coronary artery calcium score using coronary computed tomography angiography; further, non-invasive testing includes exercise stress and/or myocardial perfusion imaging or dobutamine stress test, prior to coronary angiography. Abdominal ultrasound can reveal an abdominal aortic aneurysm. Computed tomography angiography will be needed in patients with suspected mesenteric ischemia to assess the mesenteric arteries. Patients with the acute coronary syndrome and concomitant other arterial diseases have more extensive CAD and poorer CV outcomes. Similarly, PolyvascDis in patients with carotid disease and/or other PAD is independently associated with an increased risk for all-cause and CV mortality during long-term follow-up. Treatment of patients with PolyvascDis should include aggressive management of all modifiable risk factors by lifestyle changes and drug therapy, with particular attention to patients who are commonly undertreated, such as those with PAD. Revascularization should be reserved for symptomatic vascular beds, using the least aggressive strategy in a multidisciplinary vascular team approach.
多血管疾病（多血管疾病）伴动脉粥样硬化发生于>2 个血管床（冠状动脉、颈动脉、主动脉、内脏和/或外周动脉），在经历更高主要不良心血管（CV）事件发生率的患者中占 15-30%。每位具有多种 CV 风险因素或在一个动脉床出现 CV 疾病的患者，在进行有创血管造影前，应进行临床和无创性多血管疾病评估。在常规实践中，可以通过测量踝臂指数来容易地诊断外周动脉疾病（PAD）。颈动脉疾病可以通过显示狭窄百分比和/或存在斑块的双功能超声来诊断。可以通过使用冠状动脉计算机断层血管造影术确定冠状动脉钙评分来筛查冠状动脉疾病（CAD）；进一步的非侵入性测试包括运动应激和/或心肌灌注成像或多巴酚丁胺应激试验，然后再进行冠状动脉造影。腹部超声可以显示腹主动脉瘤。对于疑似肠系膜缺血的患者，需要进行计算机断层血管造影术以评估肠系膜动脉。患有急性冠状动脉综合征和同时存在其他动脉疾病的患者具有更广泛的 CAD 和更差的 CV 结局。同样，颈动脉疾病和/或其他 PAD 患者中的多血管疾病与全因和 CV 死亡率的增加独立相关，在长期随访期间。多血管疾病患者的治疗应包括通过生活方式改变和药物治疗积极管理所有可改变的风险因素，特别关注通常治疗不足的患者，如 PAD 患者。血管重建应保留给有症状的血管床，在多学科血管团队方法中采用最不具侵略性的策略。
