[Peripheral vasodilators: from the hemodynamic effect to clinical benefit]

Area of Science:

• Vascular Medicine
• Pharmacology

Context:

• Patients with chronic occlusive arterial disease of lower limbs face high risks of cardiovascular mortality, cancer, and morbidity, including coronary artery disease and strokes.
• Peripheral vasodilators are investigated for their potential to improve quality of life in these patients, as they do not impact overall mortality or morbidity.

Purpose:

• To evaluate the haemodynamic effects and clinical benefits of peripheral vasodilator drugs in patients with chronic occlusive arterial disease of the lower limbs, specifically focusing on intermittent claudication.

Summary:

• Haemodynamic studies using methods like plethysmography and 133Xe clearance demonstrated increased peripheral blood flow with drugs such as pentoxifylline, naftidrofuryl, and blufomedil.
• Despite established haemodynamic effects, many clinical trials for intermittent claudication suffered from methodological flaws, including inappropriate trial design and inadequate statistical analysis.
• Peripheral vasodilators show a demonstrated, albeit slight, benefit for functional symptoms like intermittent claudication, but their overall impact on the comprehensive care of patients with occlusive arterial disease remains limited.

Impact:

• Peripheral vasodilators primarily offer a modest improvement in quality of life for patients with lower limb occlusive arterial disease by alleviating symptoms of intermittent claudication.
• The findings highlight the need for methodologically sound clinical trials to accurately assess the efficacy of vaso-active drugs in vascular disease management.
• Current evidence suggests a limited role for peripheral vasodilators in the global management strategy for chronic occlusive arterial disease of the lower limbs, emphasizing functional symptom relief over disease modification.