Extended atherosclerotic lesion in a patient with multimorbidity: the surgeon’s view. Clinical case and historical note

Authors: Alshibaya M.D.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Case reports


DOI: https://doi.org/10.24022/1997-3187-2021-15-4-534-546

For citation: Alshibaya M.D. Extended atherosclerotic lesion in a patient with multimorbidity: the surgeon’s view. Clinical case and historical note. Creative Cardiology. 2021; 15 (4): 534–46 (in Russ.). DOI: 10.24022/1997-3187-2021-15-4-534-546

Received / Accepted:  23.08.2021 / 10.12.2021

Keywords: multifocal atherosclerosis comorbidity multimorbidity simultaneous revascularization of brain and heart

Subscribe 🔒

 

Abstract

Multifocal atherosclerosis is a common medical term that implies the presence of clinically and/or hemodynamically significant lesions of 2 or more arterial territories in one patient. The most clinically important variant of multifocal atherosclerotic lesion is the combined pathology of the coronary and brachiocephalic areas potentially dangerous by the development of life-threatening complications – myocardial infarction and ischemic stroke. The issues of surgical strategy in such patients have not yet been finally resolved. The situation is complicated in cases when along with carotid-coronary lesions there exist significant obstructions in other arterial regions – renal, visceral arteries, aorto-iliac and femoral-popliteal segments of the arterial bed. This paper describes a clinical case of combined lesions of all five main arterial territories in a patient with recently diagnosed oncological disease. We present the strategy and results of the first stage of surgical treatment: simultaneous reconstruction of the carotid, coronary and renal arteries.

References

  1. Bachmann D., Taenzer V. New x-ray contrast medium for vascular studies (angiografin). Med. Klin. 1968; 63 (10): 384–7.
  2. Hertzer N.R., Young J.R., Kramer J.R., Phillips D.F., deWolfe V.G., Ruschhaupt W.F., 3rd, Beven E.G. Routine coronary angiography prior to elective aortic reconstruction: results of selective myocardial revascularization in patients with peripheral vascular disease. Arch. Surg. 1979; 114 (11): 1336–44. DOI: 10.1001/archsurg.1979.01370350138018
  3. Hertzer N.R., Beven E.G., Young J.R., O'Hara P.J., Ruschhaupt W.F., 3rd, Graor R.A. et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann. Surg. 1984; 199 (2): 223–33. DOI: 10.1097/00000658-198402000-00016
  4. Avilova M.V., Kosmacheva E.D. Multifocal atherosclerosis: the problem of combined atherosclerotic lesion of arteries. Creative Cardiology. 2013; 1: 5–13 (in Russ.).
  5. Gracheva S.A., Biragova M.S., Glazunova A.M., Klefortova I.I., Shamkhalova M.Sh., Dzhavelidze M.I. et al. Risk factors and prognostic significance of multifocal atherosclerosis in diabetic patients. Therapeutic Archive. 2014; 86 (10): 20–6 (in Russ.).
  6. Sedykh D.Yu., Kazantsev A.N., Tarasov R.S., Kashtalap V.V., Volkov A.N., Grachev K.I. et al. Predictors of progression of multifocal atherosclerosis in patients after myocardial infarction. Kardiologiia. 2019; 59 (5): 36–44 (in Russ.). DOI: 10.18087/cardio.2019.5.10257
  7. Bekos C., Pieri L., Angelides N., Moros I. Prevalence of multifocal atherosclerosis and comorbidity on symptomatic Cypriot inpatients. Int. Angiol. 2008; 27 (5): 419–25. 8. Gallino A., Aboyans V., Diehm C., Cosentino F., Stricker H., Falk E. et al. Non-coronary atherosclerosis. Eur. Heart J. 2014; 35: 1112–9. DOI: 10.1093/eurheartj/ehu071
  8. Aboyans V., Ricco J-B., Bartelink M-L.E.L., Björck M., Brodmann M., Cohnert T. et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial disease, in collaboration with European Society for Vascular Surgery (ESVS). Eur. Heart J. 2018; 39: 763–821. DOI: 10.1093/eurheartj/ehx095
  9. Tendera M., Aboyans V., Bartelink M.-L. et al. ESC guidelines on the diagnosis and treatment of peripheral artery diseases. Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Eur. Heart J. 2011; 32: 2851–906. DOI: 10.1093/eurheartj/ehr211
  10. Meghani S.H., Buck H.G., Dickson V.V., Hammer M.J., Rabelo-Silva E.R., Clark R., Naylor M.D. The conceptualization and measurement of comorbidity: a review of interprofessional discourse. Hindawi Publishing Corporation. Nurs. Res. Pract. 2013; 2013: 1–10.
  11. Feinstein A.R. The pre-therapeutic classification of comorbidity in chronic diseases. J. Chron. Dis. 1970; 23: 455–69.
  12. Imori Y., Akasaka T., Ochiai T., Oyama K., Tobita K., Shishido K. et al. Co-existence of carotid artery disease, renal artery stenosis, and lower extremity peripheral artery disease in patients with coronary artery disease. Am. J. Cardiol. 2014; 113: 30–5.
  13. Zeller T., Rastan A., Sixt S. Chronic atherosclerotic mesenteric ischemia. Vasc. Med. 2010; 14 (4): 333–8. DOI: 10.1177/1358863X10372437
  14. Wilson D.B., Mostafavi K., Craven T.E., Ayerdi J., Edwards M.S., Hansen K.J. Clinical course of mesenteric artery stenosis in elderly Americans. Arch. Intern. Med. 2006; 166: 2095–100. DOI: 10.1001/archinte.166.19.2095
  15. Glosh S., Roberts N., Firmin R.K. Ayerdi J., Edwards M.S., Hansen K.J. Risk factors for intestinal ischemia in cardiac surgical patients. Eur. J. Cardiothorac. Surg. 2002; 21: 411–6.
  16. Bernhard V.M., Johnson W.D., Peterson J.J. Carotid artery stenosis. Association with surgery for coronary artery disease. Arch. Surg. 1972; 105: 837–40.
  17. Neumann F-J., Souza-Uva M., Ahlsson A., Alfonso F., Banning A.P., Benedetto U. et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur. Heart J. 2018; 40 (2): 87–165. DOI: 10.1093/eurheartj/ehy394
  18. Biancari F., Santini F., Tauriainen T., Bancone C., Ruggieri V.G., Perrotti A. et al. Epiaortic ultrasound to prevent stroke in coronary artery bypass grafting. Ann. Thorac. Surg. 2020; 109 (1): 294–301. DOI: 10.1016/j.athoracsur.2019.06.078

About Authors

Mikhail D. Alshibaya, Dr. Med. Sci., Professor, Head of Department; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery