REVIEW ARTICLES   

International Angiology 2000 June;19(2):97-125

Copyright © 2001 EDIZIONI MINERVA MEDICA

lingua: Inglese

A clinical approach to the management of the patient with coronary (Co) and/or carotid (Ca) artery disease who presents with leg ischaemia (Lis)

Clement D. L., Boccalon H. ¹, Dormandy J. ², Durand-Zaleski I. ³, Fowkes G. ⁴, Brown T. ⁵

From the Department of Cardiovascular Disease, University Hospital, Ghent, Belgium 1 Service d’Angiologie, CHU Rangueil, Toulouse, France 2 Department of Vascular Surgery, St. George’s Hospital, London, UK 3 Hôpital Henri Mendor, Creteil, France 4 Wolfson Unit for Prevention of Peripheral Vascular Diseases, University of Edinburgh, Edinburgh, UK 5 Merck Lipha SA, Lyon, France

The pur­pose of this doc­u­ment is to pro­vide the cli­ni­cian with easy-to-use guide­lines when faced with a ­patient with ­severe ischae­mia in the limbs requir­ing inter­ven­tion­al treat­ment; the CoC­aL­is doc­u­ment does not focus on the man­age­ment of the lower limb ischae­mia, but rath­er on the best pos­sible ­approach to the asso­ciat­ed cor­o­nary and/or carot­id ­artery dis­ease. The first part of the text deals with the epi­dem­i­olog­i­cal ­aspects of this con­di­tion fol­lowed by a descrip­tion of, and pro­po­sals for, the man­age­ment of risk fac­tors. The next part deals with the ­approach to the cor­o­nary cir­cu­la­tion and the carot­id ter­ri­to­ry. In each part atten­tion is main­ly given to the prac­ti­cal ­aspects in terms of both diag­no­sis and treat­ment; for each of these steps the costs ­involved are con­sid­ered and atten­tion given to bal­anc­ing the clin­i­cal deci­sions ­against the costs. The rec­om­men­da­tions given are ‘evi­dence ­based’ when such evi­dence ­exists and, if not, the pro­po­sals are based on the con­sen­sus of the mem­bers of the group. In many instanc­es it was appar­ent that the nec­es­sary infor­ma­tion is not avail­able in the lit­er­a­ture. The ­authors hope that the CoC­aL­is doc­u­ment may not only ­improve the man­age­ment of the vas­cu­lar ­patient but also stim­u­late fur­ther ­research in this dif­fi­cult clin­i­cal con­di­tion which car­ries a sig­nif­i­cant­ly ­increased risk for the ­patient.