Treatment of Peripheral Artery Disease (PAD) & Intermittent Claudication

TREATMENT OF PERIPHERAL ARTERY DISEASE (PAD) & INTERMITTENT CLAUDICATION

Atherosclerosis can result in ischemia of peripheral muscles just as coronary artery disease causes cardiac ischemia. Pain (claudication) occurs in skeletal muscles, especially in the legs, during exercise and disappears with rest. Although claudication is not immediately life-threatening, peripheral artery disease is associated with increased mortality, can severely limit exercise tolerance, and may be associated with chronic ischemic ulcers and susceptibility to infection.

Intermittent claudication results from obstruction of blood flow by atheromas in large and medium arteries. Treatment is primarily directed at reversal or control of atherosclerosis and requires mea-surement and control of hyperlipidemia , hyper-tension , and obesity; cessation of smoking; and control of diabetes, if present. Physical therapy and exercise train-ing is of proven benefit. Conventional vasodilators are of no ben-efit because vessels distal to the obstructive lesions are usually already dilated at rest. Antiplatelet drugs such as aspirin or clopi-dogrel are often used to prevent clotting in the region of plaques. Two drugs are used almost exclusively for peripheral artery disease. Pentoxifylline, a xanthine derivative, is thought to act by reducingthe viscosity of blood, allowing it to flow more easily through par-tially obstructed areas. Cilostazol, a phosphodiesterase type 3 (PDE3) inhibitor, is poorly understood, but may have selective antiplatelet and vasodilating effects. Both drugs have been shown to increase exercise tolerance in patients with severe claudication. Percutaneous angioplasty with stenting is often effective in patients with medically intractable signs and symptoms of ischemia.