Current management of peripheral arterial disease

Abstract

Peripheral arterial disease (PAD) is defined as atherosclerotic disease of infrarenal aorta and arteries of the lower extremities. PAD is a frequent but underdiagnosed and undertreated disease with substantial cardiovascular morbidity and mortality. Accordingly, early recognition of PAD is crucial to initiation of therapy. The ankle-brachial index (ABI) is a simple, inexpensive and noninvasive test to confirm the diagnosis of PAD and also provides risk stratification for the future cardiovascular events. Therefore, ABI should be measured in all patients with suspected PAD. Lifestyle adjustment and supervised exercise program are a major support for the therapy. Modification of treatable risk factors in conjunction with antiplatelet therapy improves cardiovascular outcomes. Cilostazol can be used as the first-line pharmacotherapy agent for the relief of claudication symptoms. Mechanical revascularization should be reserved for patients with critical limb ischemia or lifestyle limiting claudication. Remarkable technological advances in endovascular treatment have shifted revascularization strategies from traditional open surgery toward lower-morbidity percutaneous endovascular treatments. The novel therapies for increasing pain-free walking distance are under investigation. Above all, improved awareness and education in both primary physicians and the patients with cardiovascular risk factors can decrease morbidity and mortality secondary to atherosclerotic vascular disease.