Medical Management for Chronic Atherosclerotic Peripheral Arterial Disease

• Published in: Drugs (New York, N.Y.) N.Y.), 2012-11, Vol.72 (16), p.2073-2085
• Main Authors: Ali, Farzana Nawaz, Carman, Teresa L.
• Format: Article
• Language: English
• Subjects: Aspirin; Asymptomatic; Atherosclerosis; Atherosclerosis (general aspects, experimental research); Atherosclerosis - complications; Atherosclerosis - physiopathology; Atherosclerosis - therapy; Biological and medical sciences; Blood and lymphatic vessels; Blood platelets; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular system; Diabetes; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Drug therapy; Exercise Therapy; Heart attacks; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypertension; Intermittent Claudication - etiology; Intermittent Claudication - physiopathology; Intermittent Claudication - therapy; Internal Medicine; Ischemia; Ischemia - etiology; Ischemia - physiopathology; Ischemia - therapy; Lower Extremity - blood supply; Medical sciences; Medicine; Medicine & Public Health; Miscellaneous; Mortality; Patients; Pharmacology. Drug treatments; Pharmacology/Toxicology; Pharmacotherapy; Platelet Aggregation Inhibitors - therapeutic use; Quality of Life; Randomized Controlled Trials as Topic; Review Article; Risk Factors; Smoking cessation; Vascular Surgical Procedures - methods; Vasodilator Agents - therapeutic use; Vein & artery diseases
• ISSN: 0012-6667; 1179-1950
• DOI: 10.2165/11640810-000000000-00000

The generalized term ‘peripheral vascular disease’ (PVD) may be used to refer to vascular disorders in any non-coronary arterial bed. The more specific term ‘peripheral arterial disease’ (PAD) is used to refer to a more specific process, atherosclerotic disease of the lower extremities. PAD is common. Conservative estimates suggest more than 8 million Americans may be affected by PAD. Since atherosclerosis is a systemic process, PAD should be identified as a coronary heart disease risk equivalent. However, PAD remains an under-diagnosed and under-recognized risk for cardiovascular morbidity and mortality. PAD symptoms may range from non-specific ambulatory leg complaints, to typical symptoms of intermittent claudication to critical limb ischaemia with rest pain, gangrene or ulceration. These symptoms directly impact quality of life and may affect functional capacity. There are two therapeutic goals for patients with PAD: first, to reduce the risk of cardiovascular events and second, to manage the lower extremity symptoms. This manuscript reviews the medical management of patients with PAD, briefly discussing the goals of cardiovascular risk factor modification and then focusing on pharmacological management strategies for patients with intermittent claudication and critical limb ischaemia.