[Principles of angiology in lower extremity arterial disease (LEAD)]

Area of Science:

• Vascular Medicine
• Cardiology
• Atherosclerosis Research

Background:

• Lower extremity arterial disease (LEAD) is a common manifestation of atherosclerosis, significantly increasing cardiovascular event risk.
• Accurate screening and risk factor management are essential for patients with LEAD.

Purpose of the Study:

• To outline current screening, risk factor control, and treatment strategies for lower extremity arterial disease.
• To differentiate management approaches for intermittent claudication versus critical limb ischemia.

Main Methods:

• Utilizing ankle-brachial index (ABI) for LEAD screening.
• Emphasizing cardiovascular risk factor modification, including smoking cessation and statin therapy targeting LDL cholesterol <55 mg/dl.
• Detailing pharmacologic interventions like antiplatelet agents (clopidogrel, aspirin) and anticoagulation (rivaroxaban) for symptomatic LEAD.
• Highlighting revascularization as crucial for critical limb ischemia to prevent amputation.

Main Results:

• ABI measurement is recommended for LEAD screening.
• Aggressive cardiovascular risk factor control, particularly statin therapy, is a cornerstone of management.
• Pharmacological strategies include antiplatelet therapy and, in select high-risk patients, combination therapy with aspirin and rivaroxaban.
• Exercise training is the primary treatment for intermittent claudication, with revascularization reserved for severe cases or critical limb ischemia.

Conclusions:

• Effective management of LEAD requires a multi-faceted approach combining screening, risk factor modification, and tailored therapeutic interventions.
• Early diagnosis and appropriate treatment, including revascularization when necessary, are vital for limb salvage and reducing cardiovascular risk in LEAD patients.