Screening for concomitant diseases in peripheral vascular patients. Results of a systematic approach.
BACKGROUND
Patients considered for arterial surgery, have been shown to have a high incidence of coexistent cardiac, vascular and other diseases, affecting operative risk and survival. We developed a systematic workup strategy for detecting these coexistent diseases in our vascular surgical patients, mainly based on non-invasive diagnostic techniques.


METHODS
We evaluated 200 consecutive patients, admitted to the department of vascular surgery in an academic teaching hospital, in order to establish the total incidence of relevant concomitant disorders, the extent to which this screening yielded previously unknown diagnostic information, and the impact on short-term (one year) survival.


RESULTS
Coronary artery disease was present in 46% of the patients; 22% had active ischaemia, newly diagnosed in 5.5%. Impaired cardiac function was found in 37%: severely impaired in 12%, newly diagnosed in 27%. Carotid artery disease was present in 32%: critical stenoses were found in 9%; new diagnoses in 29.9%. Aortic aneurysms were present in 7%, newly diagnosed in 5%. Severe renal artery stenosis was present in 5%, newly diagnosed in 3.5%. Sixteen % of the patients had chronic obstructive pulmonary disease, newly diagnosed in 3.5%, and 4.5% had unexpected disorders, which were all new diagnoses. Overall, new diagnoses were reached in 64.5% of the population, affecting therapeutic strategy immediately in 21% of the patients. The presence of coronary artery disease and of cardiac failure were clearly related to one year survival.


CONCLUSIONS
We conclude that a systematic screening strategy, mainly based on noninvasive techniques, can detect the presence of concomitant diseases in the vascular surgical patient. Most important seem the newly diagnosed diseases altering surgical management in one out of every five patients; they also have important implications for patient prognosis.
von Kemp
K
K
Department of Vascular Surgery, Academisch Ziekenhuis Vrije Universiteit Brussel, Brussels, Belgium.
van den Brande
P
P
Peterson
T
T
Waegeneers
S
S
Scheerlinck
T
T
Danau
W
W
van Tussenbroek
F
F
Debing
E
E
Staelens
I
I
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000453:epidemiology; D001161:Arteriosclerosis / Q000453:epidemiology* / Q000601:surgery; D002340:Carotid Artery Diseases / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D005260:Female; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors