Claudication: treatment options for femoropopliteal disease

Intermittent claudication due to chronic femoropopliteal obstruction is a common disease, and patients are potentially severely disabled by the painful limitation of walking capacity. Despite major advances in pharmacological therapy of atherosclerosis, effective medication specifically for treatment of intermittent claudication is still not available. Training programs work well for patients with mild to moderate symptoms but frequently fail in patients with very compromised walking capacity. Patients with severe symptoms and markedly reduced quality of life therefore are candidates for revascularization. The preferred method of revascularization is endovascular treatment; this includes simple balloon angioplasty, debulking techniques, stent implantation, and, more recently, drug eluting technologies. Selected patients are candidates for surgery which encompasses endarterectomy of focal common femoral lesions as well as femoropopliteal bypass surgery in patients with very extensive disease or after failed endovascular approaches. The following article reviews current aspects of the management of femoropopliteal disease in patients with intermittent claudication.