Expanding roles of the cardiovascular specialists in panvascular disease prevention and treatment.

Atherosclerosis manifests as a broad spectrum of clinical pathology involving both coronary and noncoronary circulation. Peripheral artery disease (PAD) and coronary artery disease (CAD) have an important negative impact on each other with respect to treatment options and prognosis. The issue is further compounded by the underdiagnosis and undertreatment of PAD among CAD patients. There are compelling reasons why cardiovascular specialists should take an active role in the care of patients with global atherosclerotic disease. Several areas that impact cardiac patient care and thus are of particular interest to the cardiologists are renal artery disease causing hypertension or renal insufficiency; carotid artery stenosis in precoronary bypass patients; subclavian artery disease causing myocardial ischemia in patients with internal mammary bypass graft; and aortoiliofemoral arterial obstruction causing reduction in exercise tolerence and limitation in arterial access. Risk factor modifications for primary and secondary prevention are similar between CAD and PAD. Moreover, interventional cardiologists possess the necessary skills, which are transferable from coronary intervention to peripheral revascularization. To optimize outcomes, it is important for cardiovascular specialists to have a good foundation of knowledge about the natural history, treatment options and lesion selection. Collaboration with multidisciplinary specialists, including vascular surgeons and neurologists, is advisable for the treatment of PAD.