The Cardiologist in the Periphery: Indications and Usefulness of Peripheral Artery Invasive Angiography in Patients Undergoing Coronary Angiography

Although the most widely used screening techniques for extra-cardiac atherosclerotic distributions are noninvasive, in selected patients undergoing coronary arteriography a coincident angiography of certain peripheral arteries may appear justified. Subclavian artery angiography may be indicated in patients undergoing coronary angiography and candidates to internal mammary artery by pass surgery in order to prevent any subclavian coronary steal syndrome after coronary surgery using arterial conduits: in the authors experience should be always performed in patients with multiple risk factors and multivessel coronary artery disease. An extensive literature supports the need of a renal artery angiography in patients with unexplained renal dysfunction, flash pulmonary edema, and severe hypertension. Renal angiography in patients undergoing coronary angiography is diagnostic of unknown renal artery stenosis in 11% to 18% of patients, the prevalence of unsuspected renal artery stenosis increasing from 7% to 22% in patients with coronary artery disease. Aortoiliac lesions are detected in 40.5% of patients undergoing coronary angiography and in a significant proportion of patients with aortic aneurismal disease by a simple 35-40 ml injection of contrast medium at level of L1. Data given by an abdominal aorta angiography may be important for choose the correct treatment strategy in case of abdominal aorta aneurysms or renal artery stenosis especially in patients candidates to coronary bypass surgery and generally in emergent or urgent clinical setting. Invasive angiography of peripheral arteries performed by the cardiologist at the time of coronary angiography appears justified following clear criteria in patients over 60 years, multi-vessel CAD and multiple risk factors especially if candidates to cardiac surgery in order to detect potentially dangerous peripheral artery disease and to improve long-term results of myocardial revascularization or other cardiac surgical procedures.