Coronary arteriography in patients with peripheral vascular disease

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Atherosclerosis is a degenerative vascular disease with a potential for widespread involvement of virtually any arterial segment. The clinical expression may be diffuse or local; but, however limited the disease, most persons evidencing it will die eventually of some form of the disease, most often, coronary heart disease.

Symptomatic coronary heart disease considerably increases the risk of major arterial reconstruction and severely limits both the early and late postoperative prognosis. In patients with unrecognized coronary disease, myocardial infarction is a common cause of operative death and remains the most common cause of late death in postoperative asymptomatic patients.

Although it is generally recognized that the incidence of coronary heart disease is increased in patients with peripheral vascular disease, there are little hard data relating incidence and severity of coronary artery disease, especially in the asymptomatic patient. Experience with evaluation and treatment of coronary artery disease during the past two decades proves that severe coronary artery disease is common not only in symptomatic, but also asymptomatic patients and the prognosis is poorly related to symptoms. The prognosis and the operative risk are best related to the extent of coronary disease and degree of left ventricular impairment. Knowledge of the coronary anatomy should improve patient selection and ultimate management; in suitable patients, myocardial revascularization may improve the operative risk and ultimate prognosis.

This report documents a 12-month prospective study in which all patients proposed for peripheral vascular reconstructive surgery underwent coronary arteriography as part of the vascular evaluation. Excluded were patients who . . .



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