Treatment of Chronic Peripheral Arterial Disease

Abstract

Peripheral arterial disease (PAD) is a common but under-recognized problem. Intermittent claudication is the most frequent symptom of PAD, although the diagnosis of PAD is often overlooked until the patient is presented with limb-threatening ischemia. Importantly, PAD is a marker of generalized atherosclerosis and is closely associated with coronary and cerebrovascular disease. The primary causes of death in patients with PAD are myocardial infarction and stroke. Reducing risk factors is an integral and aggressive part of the treatment regimen. The recognition and diagnosis of PAD, combined with its appropriate medical management, may well reduce the overall risk of cardiovascular morbidity. When diagnosed early, both exercise and pharmacotherapy can ameliorate symptoms of claudication. augment functional performance, and improve quality of life. This review focuses on the general medical management and specific therapeutic options. Because PAD is a manifestation of generalized atherosclerosis, the principal issue in medical management of PAD is a treatment plan that modifies known risk factors for atherosclerosis and its atherothrombotic complications. All patients with PAD should be receiving antiplatelet therapy to prevent ischemic events and ACE inhibitors should be used if appropriate. Medical treatment for patients with claudication includes exercise in rehabilitation and drug therapy. It is also recognized that selected patients with claudication symptoms may benefit from catheter-based interventions, and most PAD patients with critical leg ischemia require revascularization procedures. Although many therapies for claudication have been thoroughly investigated, research continues on new treatments. In contrast, more prospective, randomized trials are needed to evaluate various therapies for treating patients with PAD.

Treatment with Pharmacological Agents in Peripheral Arterial Disease Patients Does Not Result in Biomechanical Gait Changes

“…Prescribed treatment programs for patients with PAD vary from conservative treatment, using exercise and smoking cessation, to pharmacological therapy and more aggressive management, including surgical interventions such as stenting and angioplasty (Antignani, 2003;Aronow, 2004;Christman et al, 2001;Schainfeld, 2001;Shammas & Dippel, 2005). Two pharmacological therapies are currently approved by the FDA for treatment of intermittent claudication associated with PAD.…”

Increasing Survival of Ischemic Tissue by Targeting CD47

“…8,9 Current therapies to improve vascular perfusion combine surgical vessel manipulation/bypass with vasodilators that relax vascular smooth muscle cells (VSMCs). 10,11 The bioactive gas NO is a potent vasodilator 12 that activates soluble guanylate cyclase. The increased cGMP activates cGMPdependent protein kinases and thereby decreases VSMC sensitivity to intracellular Ca 2ϩ , leading to relaxation of contractile proteins.…”

Pharmacological Treatment of Intermittent Claudication Does Not Have a Significant Effect on Gait Impairments During Claudication Pain

“…to more aggressive surgical interventions (e.g. surgical bypass and endovascular revascularization; Antignani, 2003; Aronow, 2007; Christman et al, 2001; Schainfeld, 2001). Currently, two pharmacological agents are approved by the United States Food and Drug Administration for treatment of PAD.…”