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One Thought to “Hidden complications: A case study in peripheral arterial disease”

  1. Don Wollheim, MD

    I commend the authors for providing an example of what is “really behind” athrosclerosis.

    Trained in vascular surgery, one of the fundimental concepts taught is that if the patient has a build up of a plaque under the endothelial cell lining of one artery, there is no reason at all that the patient’s entire arterial system is not at risk for the same pathology.

    My mentors were trying to get the point across that if I were to perform a “successful” Aorto-to-Whatever Bypass Graft Procedure on an individual, is it really “successful” if the patient suffers a stroke (secondary to carotid artery athrosclerosis) or a myocardial infarction (secondary to coronary artery athrosclerosis) during the operative procedure?

    For that reason, if time allowed, some form of work-up to rule out cerebral vascular and/or coronary arterial disease should be performed pre-operatively.

    If more than one arterial systems were involved with athrosclerosis, then the more critical system should be addressed first. It may not be the arterial tree with PAD.

    Thank you,

    Don Wollheim, MD

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