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International Angiology 2020 Sep 07

DOI: 10.23736/S0392-9590.20.04518-6


language: English

How to manage patients with polyvascular atherosclerotic disease. Position paper of the International Union of Angiology

Pavel POREDOS 1 , Ales BLINC 1, 2, Salvatore NOVO 3, Pier L. ANTIGNANI 4

1 Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; 2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; 3 Department PROMISE, University of Palermo, Palermo, Italy; 4 Vascular Centre Nuova Villa Claudia, Rome, Italy


Atherosclerosis is a systemic disease affecting multiple arterial territories. Patients with clinical atherosclerotic disease in one vascular bed are likely to have asymptomatic or symptomatic atherosclerotic lesions in other vascular beds. Specifically, peripheral arterial disease (PAD) often coexists with coronary and carotid disease. With progression of atherosclerotic disease in one vascular bed, the risk of clinical manifestations in other territories increases and the incidence of adverse cardiovascular events increases substantially with the number of affected vascular beds. Classical risk factors are associated with the development of polyvascular atherosclerotic disease (PVD) in different territories, however to a different extent. Risk modification represents basic treatment of patients with PVD. All modifiable risk factors should be aggressively controlled by lifestyle modification and medication. Particular attention should be directed to patients with PAD who are often undertreated in spite of the proven benefits of guideline-based approach. There is currently no proof that identification of asymptomatic atherosclerosis and PVD improves clinical outcomes in patients who are already in prevention programs. Revascularization should be performed only in symptomatic vascular beds, using the least aggressive method according to consensual decision of a multidisciplinary vascular team.

KEY WORDS: Atherosclerosis - systemic disease; Relationship between atherosclerotic diseases; Diagnostic procedures, management of risk factors; Priorities of invasive treatment

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