Significant left main coronary artery disease is defined as a greater than 50% angiographic narrowing of the vessel. In general, there are three options for the treatment of LMCA disease which include optimal medical therapy, percutaneous revascularization, or surgical revascularization, either off-pump or on-pump. It is the highest-risk lesion subset of ischemic heart disease and until recent years, coronary artery bypass grafting was the major choice of treatment. Although there is a marked increase in use of percutaneous coronary intervention in left main disease, there are still some questions about its efficacy when compared with surgery. Although bypass surgery is the gold standard, current treatment guideline recommendations canalized the treatment of this potentially lethal disease into percutaneous interventions in selected patients who had low to intermediate anatomic complexity. Left main disease with low SYNTAX scores (≤22) can be treated either by bypass surgery or percutaneously, whereas SYNTAX score > 32 is an indication for only coronary artery bypass surgery. The heart team should always be in collaboration, give therapeutic options to patients and decide the best treatment strategy for the welfare of the patient.
Part of the book: Coronary Artery Bypass Graft Surgery
Peripheral artery disease (PAD) is one of the most common diseases affecting quality of life. Claudication is the most frequent sign. If left untreated, PAD may cause serious daily life disturbances and may cause extremity losses, especially in elderly and diabetic patients. Restoration of blood flow from the aorta to the femoral arteries and from the femoral arteries to the popliteal arteries necessitates complex operational procedures. Most of these patients have concomitant coronary diseases. In such patients, open surgical repair with vascular grafts by the aid of general anesthesia increases both mortality and morbidity. Although femoral arteries are the most common site for PAD, iliac impairment is not so rare. In patients with combined iliac and femoral artery diseases, popliteal artery approach is a safe and effective technique for percutaneous revascularization. In this chapter, we share our experience with interventional percutaneous revascularization through popliteal approach, mainly using drug eluting balloons and stents, by the aid of mechanical thrombectomy devices with the highlights of current literature review.
Part of the book: Peripheral Arterial Disease