[Management of patients with intermittent claudication]

Area of Science:

• Vascular Medicine
• Cardiovascular Surgery
• Interventional Cardiology

Context:

• Intermittent claudication is a common symptom of peripheral artery disease, significantly impacting quality of life.
• Effective management requires a multi-faceted approach addressing underlying atherosclerosis and specific arterial lesions.

Purpose:

• To outline the current best practices for managing intermittent claudication.
• To delineate the role of medical therapy, physical training, endovascular procedures, and surgical revascularization.

Summary:

• Comprehensive management begins with aggressive treatment of atherosclerosis, including smoking cessation, antiplatelet therapy, beta-blockers, ACE inhibitors, and lipid-lowering agents to achieve LDL cholesterol < 1 g/L.
• Treatment strategies for intermittent claudication are tailored to the nature and location of arterial lesions.
• Endovascular procedures are highly effective for iliac stenosis or short occlusions, offering substantial symptomatic relief. Medical management combined with physical training is the primary approach for most patients. Surgical revascularization is infrequently indicated.

Impact:

• Provides a clear treatment algorithm for clinicians managing patients with intermittent claudication.
• Highlights the importance of a holistic approach to atherosclerosis management.
• Emphasizes the limited role of surgical intervention in favor of less invasive or conservative measures.