Thromboembolism and antithrombotic therapy in peripheral arterial disease

Atherosclerosis complicated by thromboembolism is the main cause of obstructive arterial disease in the legs. Two studies from West Germany suggest that antiplatelet drugs may slow the progress of atherosclerosis in leg arteries and prevent occlusive thrombosis under some circumstances. The same agents may also reduce the risk of rethrombosis after successful vascular repair in the femoropopliteal region; in one trial, aspirin decreased the incidence of reocclusion after thromboendarterectomy and, in another, the combination of aspirin and dipyridamole was effective after bypass with synthetic material. Antithrombotic drugs are used in most centers after percutaneous transluminal angioplasty, but there is no definite evidence for their need. Thus, it appears that in contrast to cardiac and cerebrovascular disease, few efforts have been made to determine the true value of antithrombotic therapy in peripheral arterial disease. The management of acute thromboembolism in the legs requires a multidisciplinary approach. Depending on the type (embolic or thrombotic), length and localization of the arterial occlusion, surgical (embolectomy, thromboendarterectomy, peripheral bypass surgery) or nonsurgical (systemic fibrinolysis or local thrombolytic therapy with or without balloon angioplasty) treatment is preferred. The importance of nonsurgical therapeutic approaches may become even greater in elderly patients with a poor operative risk. This review discusses the available therapeutic modalities in acute and chronic peripheral thromboembolic arterial disease.