Coronary artery disease (CAD) is the leading cause of morbidity and mortality in many countries over the world. In recent years, the combination of atherosclerosis of coronary and peripheral artery is increasing which in turn becoming a crucial issue of interventional cardiology and cardiovascular surgery at present days. According to the data reported by different autors (), the incidence of multifocal atherosclerosis (in patients with CAD) varies from 8.1 to 33.9%. In our study prevalence of multifocal atherosclerosis was 12.8% and of all these cases, majority had multiple involvement of coronary arteries as well higher degree of severity in stenosis. Management of surgery in patients with multisystem aterosclerosis very importent issueses of vascular surgery. The choice and strategy of reconstructive surgery still remains controversial when CAD coexists with other peripheral arterial disease. Surgical management of concomitant diseases of coronary, cerebral and peripheral arteries are certainly the most important issue of vascular surgery. In addition to traditional surgical approaches for all common vascular diseases, the endovascular surgical management is developing rapidly. Reported herein is the some cases of a patient presenting with associated atherosclerotic lesion of the coronary artery, extracranial artery and artery of lower extremities. We have different reconstructive vascular surgery patients with multifocal atherosclerosis. There are included some cases of vascular taktics for multifocal atherosclerosis.

Endovascular repair of descending thoracic aortic aneurysm is an attractive approach. Candidates for endovascular repair should have an inner aortic diameter of 23-37 mm adjacent to the aneurysm without signifi cant thrombus or calcifi cation in these so called landing zones. They should have at least 2 cm of normal aorta both proximal and distal to the aneurysm to ensure adequate fi xationof the divece. Endografting of the descending thoracic aorta requires preoperative measurements of the diameter of the proximal and distal necks of the aneurysm, tratment length, and proximal and distal angulation. This information can be obtained from CT-ic angiography using three dimensional reconstruction.