Medical management of peripheral arterial disease

Abstract

Summary. Whether symptomatic or not, peripheral arterial disease (PAD), atherosclerosis in the arteries of the lower extremities, is a common disorder in the general population. The prevalence increases with age and under the influence of vascular risk factors. The most classic symptomatic expression of PAD is intermittent claudication. However, the majority of patients with PAD is asymptomatic or has leg symptoms other than classic intermittent claudication. Both symptomatic and asymptomatic subjects with PAD have increased mortality rates, mainly due to cardiovascular and cerebrovascular expressions of atherosclerotic disease. This review focuses on the current available medical therapies for PAD, including risk‐factor modification and antiplatelet therapies, as well as strategies for symptomatic relief in both patients with intermittent claudication and patients with critical limb ischemia. In general, risk factor modification and antiplatelet therapy is essential in all patients with PAD to prevent systemic atherosclerotic complications. Furthermore, for symptomatic relief exercise therapy is the main intervention while pharmacological treatment should be only complementary. In patients with critical limb ischemia, when revascularization therapy is not possible, an attempt should be made to avoid amputation with conservative treatment using analgesics, vasodilators and/or anticoagulants. In case of an acute onset of critical limb ischemia, thrombolysis is indicated.

Extracorporeal Blood Oxygenation and Ozonation (EBOO): A Controlled Trial in Patients with Peripheral Artery Disease

“…Prolonged ivP administration over a period of 28 days did not improve objective or subjective measures of PAD symptoms in this trial, demonstrating the difficulty of treating stage IV PAD with current therapies (53)(54)(55)(56)(57)(58)(59).…”

“…Peripheral arterial disease is treated medically and surgically, however few therapies for skin lesions, especially extensive ones, have proven beneficial (53)(54)(55)(56)(57). Intravenous prostacyclin therapy is known to have positive effects on patients with PAD, though not all results have been univocal (58)(59)(60)(61)(62)(63).…”

Rifalazil and Other Benzoxazinorifamycins in the Treatment of Chlamydia‐Based Persistent Infections

“…Symptoms can be quantified and reproducibly measured with treadmill testing of either the distance, or the time patients are able to walk at constant speed, and varying resistance. Whereas this painful symptom may contribute to a diminished quality of life, and, by limiting exercise, may contribute an added risk to general health, PAD carries a higher risk of morbidity and mortality in asymptomatic patients as well [96,97].…”

Potential Therapeutic Gene for the Treatment of Ischemic Disease: Ad2/Hypoxia-Inducible Factor-1α (HIF-1)/VP16 Enhances B-Type Natriuretic Peptide Gene Expression via a HIF-1-Responsive Element

“…Fully 7.5% of the US population aged 60 to 64 years in United States is affected by PAD, which is primarily related to atherosclerosis (Bendermacher et al, 2005;Patel et al, 2005). The most common treatment for critical limb ischemia is surgical bypass and percutaneous revascularization (Patel et al, 2005).…”