In which ways have endovascular techniques modified the management of polyvascular patients?

The concept of multifocal atherosclerotic patient is well established.In the last decade, endovascular innovations that include balloonangioplasty, stenting and endoluminal grafting have considerablychanged therapeutic strategies for vascular diseases and consequentlythe management of "multifocal atherosclerotic patients".Moreover, the number of patients undergoing vascular procedureshas risen dramatically due to the increase of the elderly populationin developed countries. Age becomes a more important risk factorin patients undergoing common vascular operations and greatefforts must be made to treat these elderly patients with less invasivemethods.The focus of therapy is now moving toward maximal revascularization with minimal invasiveness. Endovascular procedures targetthe risk group of "multifocal atherosclerotic patients".The purpose of this study is to define in which ways endovasculartechniques have modified the management of polyvascular patients.The advent of percutaneous coronary interventions (PCI), for treat -ing coronary arterial disease (CAD) resulted in a decrease in theneed of coronary artery bypass graft (CABG). Consequently, for thetreatment of CAD, the rate of PCI is 80% versus 20% of CABG.Furthermore beating heart bypass operations are also used for selectedpatients, with reduced morbidity. Now in Europe, around 30-35% of procedures are carried out without extracorporeal circulation.Abdominal aortic aneurysms (AAA) remain an important problem.Although the reported operative mortality for elective AAA surgerywas frequently quoted as being less than 4%, Dr. Parodi revolutionizedthe treatment of infrarenal AAA when he performed the firstsuccessful endovascular aneurysm repair (EVAR) in 1990.EVAR represents a drastic technical advance in the management ofinfrarenal AAAs and already provides a relatively safe alternativeto traditional open operations, especially in high -risk candidates.For treatment of patients with carotid stenosis, feasibility of carotidangioplasty and stenting (CAS) has been proven by a wide range ofvarious works. CAS techniques continue to develop rapidly.In the light of this exciting new technology, we will see in whichways the endovascular techniques have modified our strategy andwhat our current recommendations are in three cases :- myocardial revascularization and carotid artery disease ;- carotid stenosis and concomitant coronary artery disease ;- abdominal aortic aneurysms and concomitant coronary artery disease.Endovascular procedures will continue to mature and have the potentialin the future to monopolize the field of vascular surgery.Probably, they will completely modify the management of the polyvascularpatient.