Coexistent atherosclerotic renal artery and lower limb peripheral artery disease in patients with symptomatic triple vessel coronary artery disease

Abstract

Objective: The study was designed to estimate the prevalence of concomitant peripheral artery disease (PAD) in patients with symptomatic triple vessel coronary artery disease (TV-CAD) and to determine the associated risk factors. Materials and Methods: A total of 48 newly diagnosed patients with symptomatic critical triple-vessel coronary artery disease on coronary angiogram were included in the study. These patients had not undergone any previous revascularization procedure (Percutaneous coronary intervention (PCI) or Coronary Artery Bypass Grafting (CABG). The coronary, renal and lower-limb angiograms were performed via the femoral artery access. Patients identified to have critical triple vessel coronary artery disease, also had renal and lower-limb angiographic shoots taken through hand-injections. Results: The coexistence of atherosclerotic renal artery stenosis (ARAS) and lower-limb peripheral artery disease (LL-PAD) was seen in 33 % cases (16 out of 48). Only one patient of the overall 16 patients who had LL-PAD was symptomatic for the LL-PAD and the patient had a history of intermittent claudication. A significant number of patients, who were noted to have LL-PAD during the study showed involvement of below knee arteries e.g. Anterior Tibial Artery (ATB) and Posterior Tibial Artery (PTB), which were typically in the 4-5 mm diameter range. Conclusion: The presence of multiple risk factors should prompt evaluation for PAD in patients identified to have multi-vessel CAD, as both CAD and LL-PAD often co-exist and have similar risk-factor profile. Also, patients with concomitant atherosclerotic disease may benefit with more intensive revascularization strategies and novel anti-thrombotic approaches.