Pharmacologic therapy for peripheral arterial disease and claudication

Abstract

Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis that is associated with a high risk of cardiovascular mortality and significant limitation in function because of limb ischemia. Patients with PAD should be considered to have significant coronary and cerebral arterial disease that requires aggressive risk factor management, including the prescription of antiplatelet drugs, to lower the subsequent risk of myocardial infarction, stroke, and death. In the population with PAD, level 1 and level 2 evidence supports the use of statin drugs for lipid management, angiotensin-converting enzyme-1 inhibitors for blood pressure control, and aspirin or clopidogrel as antiplatelet agents. Once this is accomplished, the severity of limb symptoms should be assessed, and a structured exercise program or the selected use of drugs such as cilostazol to treat claudication should be prescribed. In patients primarily considered for surgical treatment, antiplatelet and anticoagulant drug therapy can be used as a means of promoting graft patency, and beta-adrenergic blockers can be used as a means of reducing the perioperative risks associated with vascular surgery.

The Cardioprotective Effect of a Statin and Cilostazol Combination: Relationship to Akt and Endothelial Nitric Oxide Synthase Activation

“…CIL has antiplatelet and vasodilatatory properties [32] and is approved in the US for treatment of patients with intermittent claudication symptoms related to peripheral arterial disease [32,33]. Studies have shown that CIL may be efficacious also in coronary artery disease.…”

“…Cilostazol (CIL) is a clinically available phosphodiesterase 3 inhibitor, increasing cellular levels of cyclic AMP (cAMP), with antiplatelet and vasodilatatory properties [32] and is FDA-approved for treatment of patients with intermittent claudication symptoms related to peripheral arterial disease [32,33]. We hypothesized that CIL would augment the protective effect of statins as (1) CIL activates Akt [34][35][36][37][38] and eNOS [34] and may protect against ischemia-reperfusion injury [37][38][39][40]; (2) in addition to increasing eNOS phosphorylation by Akt, by increasing intracellular cAMP CIL may also activate protein kinase A (PKA) which has also been reported to activate eNOS [23];…”

In Vivo Human MCP-1 Transfection in Porcine Arteries by Intravascular Electroporation

“…It has been estimated that approximately 20Y30% of the elderly population are affected by PAD (1Y4). Pharmacologic therapy of PAD is usually limited to risk-factor modification (i.e., cholesterol or blood pressure lowering for example by statins or angiotensin-converting enzyme inhibitors, respectively), vasodilatation using prostaglandin analogs, and prevention of thrombotic complications (5,6). Because surgical revascularization or percutaneous transluminal angioplasty (PTA) is not possible in all patients and results in a higher restenosis rate compared to the coronary circulation, an effective nonsurgical therapy may provide improved revascularization and preservation of limbs.…”

Additive CT-gesteuerte lumbale Sympathikolyse bei Patienten mit pAVK

“…Die pAVK ist mit einem hohen Risiko für Myokardinfarkt, Schlaganfall und vaskulär bedingten Tod verbunden [1]. Die Beeinträchtigung der Durchblutung der Extremitäten durch Stenosen oder Verschlüsse der versorgenden Arterien zeigt mit zunehmendem Lebensalter eine ansteigende Prävalenz [17,18,32]. Das Fortschreiten der Erkrankung wird durch Risikofaktoren wie Rauchen, Diabetes mellitus, Hyperlipoproteinämie, Hypertonie, vorbestehende kardiovaskuläre Erkrankungen und Hyperhomo zysteinämie begüns-tigt [1, 9,17].…”