Pharmacotherapy for peripheral arterial disease: emerging therapeutic options

Although endovascular therapy has revolutionized the management of patients with peripheral arterial disease (PAD), noninterventional regimens, such as structured exercise therapy, atherosclerotic risk factor modification, and pharmacotherapy, are effective in patients suffering from mild-to-moderate PAD and intermittent claudication (IC). For more than a decade, the only pharmacologic therapy for IC available in the United States was pentoxifylline, which had demonstrated superiority in improving walking distances but offered minimal clinical benefit. Recently, basic research into the pathophysiology of IC has led to the development of cilostazol, a new pharmacologic agent approved for treatment of this condition in 1999. Ongoing research in the use of angiogenic growth factors has further broadened the range of potential alternatives to treatment in patients with PAD. Revascularization procedures, including nonsurgical and surgical techniques, can thus be reserved to improve patency and reduce the risk of limb loss in patients with PAD and IC with more severe impairment.