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EAPCI column

Peripheral interventions: how long will they remain a missed opportunity?

Many are the reasons supporting the involvement of interventional cardiologists in peripheral interventions. First of all, coronary, peripheral and carotid disease are manifestations of the same systemic disease (atherosclerosis), sharing the same pathogenesis as well as the predisposing factors. Coronary atherosclerosis management represents the core activity of interventional cardiologists and they have a profound knowledge of the management of the risk factors for atherosclerosis. In addition, the patterns of catheter-based treatment and complication management are similar, and interventional cardiology is the only specialty focused exclusively on catheter-based endovascular interventions. Moreover, the same patient may have multiple manifestations of atherosclerosis (multilevel disease) and patients are delighted if the same doctor can take care of their multiple pathologies. Finally, although the patient seeks out medical attention because he complains of claudication, his long-term prognosis will be ultimately determined by coronary artery disease.

Of course, the target organs (e.g., heart, brain or kidneys) as well as the anatomy and physiology of the arterial supply are different. Therefore, dedicated training is necessary for an interventional cardiologist before embarking in peripheral procedures. Based on the extended life expectancy of patients, the association of symptomatic atherosclerosis with age and the increased prevalence of cardiovascular risk factors like obesity and diabetes, one would expect to see a massive increase in peripheral procedures performed by cardiologists. However, this does not seem to be the case, at least in Europe, with important differences within the various vascular districts treated. Nobody questions the right to make any attempt to spare patients with critical limb ischaemia devastating amputations, and these procedures have shown a steady growth, only limited by the time requested for the specialists treating these patients (diabetologists, geriatricians, vascular medicine specialists, primary care physicians), to realise the potential benefit offered by these procedures. For carotid and renal stenting, however, the situation has been very different.

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