Cor Vasa 2018, 60(1):e9-e17 | DOI: 10.1016/j.crvasa.2017.12.005

Panvascular disease - Diagnosis and management

Katerina K. Naka^a, Victor Aboyans^b,c, Charalambos Vlachopoulos^d,*

^a 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina Medical School, Ioannina, Greece

^b Inserm 1094, Tropical Neuroepidemiology, Limoges University, Limoges, France

^c Department of Cardiology, Dupuytren University Hospital, Limoges, France

^d 1st Department of Cardiology, National and Kapodistrian University of Athens, Greece

Panvascular disease (PVD) increases significantly the risk for cardiovascular events (myocardial infarction, stroke and cardiovascular death); the more sites affected, the greater the risk of a major cardiac event. Despite its high incidence and severe cardiovascular prognosis, PVD has still not been well studied. History of risk factors and co-morbidities, as well as a detailed physical examination, are mandatory in the initial screening and diagnostic work-up. The ankle-brachial index and various non-invasive imaging methods such as duplex ultrasound, computed tomography or magnetic resonance angiography are used for the diagnosis of atherosclerosis in various vascular beds, while digital subtraction angiography is currently used almost exclusively in association with endovascular procedures. Appropriate utilization of techniques is based on international guidelines and a multidisciplinary discussion for each case.
Management of a patient diagnosed with PVD can be very complex. Secondary preventive measures and aggressive medical treatment are needed to reduce excess cardiovascular risk. Whether routine screening for atherosclerosis at various sites in the arterial tree in all or selected patients may alter treatment to improve outcome in these patients has not been shown.
In the lack of hard evidence, individualized decision-making is needed with the collaboration of many specialties in a multidisciplinary approach. In general, the more symptomatic lesion or the lesion with the strongest prognostic impact should be treated first. In selected cases combined interventions can be done. Perioperative cardiovascular complications are common in patients with PVD, thus preoperative targeted screening may be needed.
Clinical studies are needed to identify more effective approaches to diagnose and treat these patients. A single trial performed so far failed to demonstrate a panvascular screening in patients with severe coronary artery disease. Meanwhile, a multidisciplinary team is often needed to optimize short- and long-term prognosis.

Keywords: Ankle-brachial index; Carotid artery disease; Computed tomography angiography; Diagnosis; Magnetic resonance angiography; Panvascular disease; Peripheral artery disease; Treatment

Received: November 8, 2017; Accepted: November 15, 2017; Published: February 1, 2018  Show citation