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(Circulation. 2004;109:3136-3144.)
© 2004 American Heart Association, Inc.

Clinician Updates

Concomitant Peripheral Arterial Disease and Coronary Artery Disease

Therapeutic Opportunities

John A. Bittl, MD; Alan T. Hirsch, MD

From the Ocala Heart Institute, Munroe Regional Medical Center, Ocala, Fla (J.A.B.), and the Vascular Medicine Program, Minneapolis Heart Institute and Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.T.H.).

Correspondence to John A. Bittl, MD, Ocala Heart Institute, 1511 SW 1st Ave, Ocala, FL 34474. E-mail jabittl@aol.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In the decade ahead, patients and primary care physicians will increasingly recognize the clinical burden of peripheral arterial disease (PAD). As new advances in the treatment of coronary artery disease continue to reduce mortality and morbidity, caregivers will increasingly confront the problem of concomitant "noncoronary" arterial disease. Cardiovascular physicians should assume a more proactive clinical role, along with their vascular medicine colleagues, to encourage new therapeutic opportunities for the treatment of arterial disease affecting multiple vascular beds. Multivascular therapeutic approaches are needed because atherosclerosis has a common systemic pathogenesis and simultaneously affects multiple circulations.

Deployment of PAD therapies must be guided by an appreciation of the diverse natural histories associated with peripheral arterial diseases. Ideal patient-focused clinical outcomes may be defined when: (1) coronary therapies improve myocardial perfusion, reduce the risk of myocardial infarction and heart failure, and improve patient survival; (2) carotid therapies permit survival with reduced incidence of stroke; (3) renal artery disease therapies diminish the need for renal replacement therapies (dialysis and transplantation); and (4) lower-extremity PAD therapies improve functional status, foster wound healing, and decrease amputation rates. The achievement of health without amputation, stroke, end-stage renal failure, or myocardial infarction will require clinical wisdom. The calculation of risk/benefit ratios becomes increasingly complex with multi-circulation intervention and should be calibrated to the individual at risk.

Patients with diffuse atherosclerotic disease traditionally have sought consultation and care from multiple specialists. The subspecialty of vascular medicine provides coordinated diagnostic and therapeutic efforts using a team approach. The case examples . . . [Full Text of this Article]