Medical management of peripheral arterial disease

Patients with atherosclerotic peripheral arterial disease (PAD) of the lower extremities have an inadequate blood flow to exercising muscle. This results in a walking impairment due to intermittent claudication (exercise-induced cramping in the muscles of the lower extremities). Persons with PAD are at increased risk of cardiovascular events, with an excess mortality from strokes and myocardial infarction. The medical treatment of patients with PAD is directed at intensive risk factor modification to decrease cardiovascular morbidity and mortality. A second treatment goal is to improve exercise performance and functional capacity. To this end, a limited number of drugs have been developed to improve claudication symptoms. In addition, the nonpharmacologic treatment of claudication includes exercise rehabilitation. Previous studies have shown that an exercise rehabilitation program results in significant increases in treadmill peak walking time, peak oxygen consumption, and pain-free walking time. Patients also reported improved walking ability and functional status in the community setting. Therefore, optimal treatment of this patient population includes cardiovascular risk factor modification, selective use of claudication drugs, and exercise rehabilitation.