Can simultaneous coronary and peripheral angiography alter the treatment planning in Fontaine stage IV peripheral arterial disease?

Abstract

Objectives

Peripheral arterial disease (PAD) and coronary artery disease (CAD) are major contributors to global morbidity and mortality. Many PAD patients remain asymptomatic for CAD, which often leads to undetected coronary artery involvement. This hidden coronary disease poses significant risks, particularly following peripheral revascularization, as increased cardiac demand can precipitate complications.

Methods

This cross-sectional descriptive study assessed the prevalence of coronary artery stenosis in patients with Fontaine Stage IV peripheral arterial disease. Simultaneous angiography of both the coronary and lower extremity arteries was performed, and the severity of arterial stenosis was rigorously evaluated. The correlation between the extent of peripheral and coronary artery disease was analyzed.

Results

A total of 60 patients (63.3% male, 36.7% female; mean age 65.23 ± 9.86 years) were included. Comorbidities were common, with 90% having diabetes, 50% hypertension, 23.3% hyperlipidemia, and 30% smoking history. Severe peripheral artery stenosis was frequently observed, particularly in the posterior tibial artery (total occlusion in 26.6% and 20% of the right and left arteries, respectively). Significant coronary involvement was also prevalent, with 51.7% exhibiting three-vessel disease. Coronary revascularization was required in the majority of cases (CABG: 40%, PCI: 35%), with a higher proportion among women (77.2%) and men (73.7%).

Conclusion

This study highlights the necessity of comprehensive coronary evaluation in patients with advanced lower limb ischemia. A substantial proportion of these patients have silent but critical coronary disease, which, if left unaddressed, could result in serious post-revascularization complications.