Management of peripheral arterial disease

The risk factors, epidemiology, diagnosis, and treatment of peripheral arterial disease are reviewed. Peripheral arterial disease is characterized by a gradual reduction in blood flow to one or more limbs secondary to atherosclerosis. Risk factors include smoking, diabetes mellitus, hyperlipidemia, and hypertension. The most common clinical manifestation is intermittent claudication. The prevalence of intermittent claudication in people over the age of 50 is 2-7% for men and 1-2% for women. The ankle:brachial pressure index (ABPI) is a useful measure of disease severity; an ABPI of 0.5-0.9 is common in intermittent claudication. The goals of therapy are to relieve or reduce ischemic symptoms, alleviate disability, improve in functional capacity, prevent progression that may result in gangrene and limb loss, and prevent cardiovascular and cerebrovascular events. Treatment includes risk-factor modification, drug therapy (primarily with antiplatelet agents), and revascularization procedures. Aspirin has been shown to be effective in reducing the associated risk of myocardial infarction and stroke. Ticlopidine appears to be a reasonable alternative for patients who are hypersensitive to aspirin. Clopidogrel has been shown to be more effective than aspirin in patients with recent myocardial infarction, recent stroke, or established peripheral arterial disease. There is controversy over the appropriate treatment for acute arterial occlusions. Risk-factor modification and antiplatelet drugs are the mainstays of therapy for patients with intermittent claudication, the most common manifestation of peripheral arterial disease.