INTRODUCTION
Cardiovascular diseases (CVD) are the leading cause of death in Western countries. Between 2005 and 2015, the number of deaths from CVD increased by 12.5% worldwide. An estimated 17.9 million people died from CVD, representing 32% of all global deaths. Of these deaths, 85% were due to myocardial infarction and stroke 1, 2. Atherosclerosis, as the main pathophysiological process of CVD, remains the leading cause of morbidity and mortality in developed countries3 and can be detected even in young adults and children 4. Coronary artery disease (CAD) and peripheral artery disease (PAD) have a common underlying pathology of atherosclerosis. The comorbidity of CAD and PAD has long been well-known5-20. The incidence of both significant and non-significant atherosclerotic lesions in peripheral arteries in patients with established CAD is presented in Figure 1. The risk factors of both are well-defined. Risk factors (hypertension, diabetes, smoking, hypercholesterolemia) with accompanying typical angina have traditionally served as an indication for invasive coronary angiography (CA). However, in daily clinical practice, many patients do not present the typical syndrome of CAD. Thus the invasive diagnosis should be preceded by a noninvasive test. Furthermore, patients without electrocardiography findings and increased troponin levels may benefit from non-invasive diagnostics.
In accordance with the recent guidelines established by the European Society of Cardiology (ESC), following the exclusion of acute coronary syndrome (ACS), diagnostic imaging modalities such as coronary computed tomography angiography or single-photon emission computed tomography are recommended 21. Despite many advantages, these examinations have contraindications, are less available, and cost-prohibitive (Table 1). Moreover, recent ESC guidelines indicate solely carotid artery ultrasonography (CAUS) as a tool that should be considered for detecting CAD plaque in suspected patients. A review of current guidelines and promising approaches to atherosclerotic plaque assessment is necessary to enhance the diagnosis, management, and treatment of CAD in clinical practice.
The available, costless, safe, and sensitive tool in atherosclerosis assessment is ultrasonography (US). Most studies investigated carotid and femoral arteries, although their superficial location allows US imaging with high resolution. Other vascular beds, such as the renal arteries, abdominal aorta, and iliac arteries, may pose challenges to accessibility. Despite some limitations is useful to detect high risk patients given that the US become appropriable for risk stratification22.
In this review, we: i) underline coexisting PAD and CAD, ii) describe the role of vascular US in CAD diagnosis, and iii) characterize the usefulness of US in CVD risk assessment.