Mirela-Anca Stoia
University of Medicine and Pharmacy Cluj-Napoca, Romania
Title: Cardiovascular risk evaluation before vascular surgery- to be practically or to be pragmatic?
Biography
Biography: Mirela-Anca Stoia
Abstract
Statement of the Problem: Patients with peripheral artery disease (PAD) have multisite arterial lesions especially in coronary and cervical arteries, often less symptomatic and diagnosed, which increase dramatically the mortality through myocardial infarction and stroke and the duration of hospitalization, especially after vascular surgery. The purpose of this study was to assess the role of an overall cardiac and arterial screening, including non-invasive and invasive investigation, revealing the role of more accessible examinations, in order to estimate the perioperative cardiovascular risk and to define the therapeutic strategy for revascularization.
Methodology & Theoretical Orientation: We studied 142 patients with critical leg ischemia (CLI) scheduled for vascular surgery. The history, clinical examination, cardiovascular risk factors (CVRF) profile and systematic ECG examination of these patients looked for suspected atherosclerotic lesions in coronary and cervical arteries beside the symptomatic peripheral arterial territory. In patient presented acute coronary syndrome in the last six months or Eagle score >2, the coronary angiography was performed systematically. In all patients cervical arterial ultrasonography and in selected patients, cervical arterial angiography was performed.
Findings: More of 50% of CLI patients had multiple CVRF. We find significant coronary and/or cervical arterial lesions in 44.4% of the investigated subjects. Hemodynamic significant coronary arteries stenosis >70% were diagnosed in 29.6% and hemodynamic significant cervical stenosis >70% or carotid thrombosis were diagnosed in 11.8% of patients with CLI. The clinical and imagistic non-invasive algorithm selecting patients with CLI and significant stenosis in the coronary and/or arterial cervical territories was confirmed through invasive angiography evaluation in 69.1% of cases.
Conclusion & Significance: Demonstrating the multisite arterial lesions profile in patients with CLI and with significant stenosis in coronary and/or cervical arteries changes the treatment strategy and management. In these cases, medical therapy should be more intensive and revascularization interventions in coronary and cervical arteries might precede peripheral arterial revascularization procedures.