Evaluation and management of patients with both peripheral vascular and coronary artery disease

B. J. Gersh, C. S. Rihal, Thom W Rooke, D. J. Ballard

Research output: Contribution to journalReview article

107 Citations (Scopus)

Abstract

The prevalence of serious angiographic coronary artery disease ranges from 37% to 78% in patients undergoing operation for peripheral vascular disease. Clinical studies have demonstrated that cardiac outcome after peripheral vascular surgery is not adequately predicted by the standard criteria of history, physical findings and rest electrocardiogram. An adequate exercise work load, left ventricular function and thallium redistribution have proved important in perioperative risk stratification. The choice of a perioperative functional cardiac test depends on patient-related factors and the nature of the peripheral vascular operation. Although procedures involving aortic cross-clamping exert a greater hemodynamic stress than do carotid endarterectomy and femoral popliteal surgery, late cardiac morbidity and mortality are significant in all patients with atherosclerotic disease. The decision to proceed with preoperative coronary angiography and myocardial revascularization should be based primarily on independent of the peripheral vascular procedure. However, peripheral vascular surgery may influence the timing of myocardial revascularization. Patients with high risk or unstable coronary artery disease may benefit from preoperative coronary revascularization, although this hypothesis remains unproved. In all patients, careful monitoring during and after operation is essential. All patients with peripheral vascular disease should be considered to be at lifelong risk for fatal and nonfatal cardiac events and should undergo appropriate clinical and laboratory evaluation and be treated accordingly.

Original languageEnglish (US)
Pages (from-to)203-214
Number of pages12
JournalJournal of the American College of Cardiology
Volume18
Issue number1
StatePublished - 1991
Externally publishedYes

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Peripheral Arterial Disease
Blood Vessels
Coronary Artery Disease
Myocardial Revascularization
Peripheral Vascular Diseases
Carotid Endarterectomy
Thallium
Physiologic Monitoring
Thigh
Workload
Coronary Angiography
Left Ventricular Function
Constriction
Thoracic Surgery
Electrocardiography
Hemodynamics
History
Exercise
Morbidity
Mortality

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Evaluation and management of patients with both peripheral vascular and coronary artery disease. / Gersh, B. J.; Rihal, C. S.; Rooke, Thom W; Ballard, D. J.

In: Journal of the American College of Cardiology, Vol. 18, No. 1, 1991, p. 203-214.

Research output: Contribution to journalReview article

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