Evaluation of the coronary risk in sclerotic arterial diseases of the lower limbs

The prevalence of coronary artery disease is very high among patients with peripheral arterial disease. The fate of these patients mainly depends on their coronary risk. Most often, the evaluation of coronary risk is performed when a surgical intervention on the aorta or lower limb arteries is decided. However, the late risk, at medium and long term, of coronary disease is much higher than its immediate perioperative risk. Diagnostic work-up is complex. Symptoms of coronary insufficiency may be masked by the limited capacity to physical exercise, but remain essential indices. None of the available complementary investigations has a satisfactory predictive value. Diagnostic explorations and therapeutic decisions for coronary heart disease have to be discussed in each case, according mainly to age and symptoms, and to whether peripheral arterial surgery is required.